Glen Isamu Komatsu, M.D.

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

A35086 Issued in CA

Practice address

6069 Woodfern Dr
Rancho Palos Verdes, CA 90275-2263

Phone

(310) 375-4585

Fax

(310) 375-1735

NPI assigned

Aug 13, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pediatric MedicineAlso: Hospice/Palliative Care

Education

University of Arizona College of Medicine, 1978

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence at Home With Compassus Hospice Care la County Hospice, Torrance, CA, CCN 051512

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Providence Little Company of Mary Medical Center Torrance

  • General Acute Care Hospital
  • Torrance, CA
  • NPI 1003084211
  NPD Authorized official
• CP la County S-Ca Hospice, LLC

  dba Providence a Home with Compassus Palliative Care, So Cal

  • Community Based Hospice Care Agency
  • Torrance, CA
  • NPI 1225850480
  NPD (past)
• Gardena Hospital LP

  dba Memorial Hospital of Gardena Pharmacy

  • Institutional Pharmacy
  • Gardena, CA
  • NPI 1669491700
  NPD (past)
• Providence Health System - Southern California

  • Psychiatric Hospital Unit
  • San Pedro, CA
  • NPI 1154349371
  NPD (past)
• Providence Health System Southern California

  dba Providence Little Company of Mary Medical Center Torrance

  • General Acute Care Hospital
  • Torrance, CA
  • NPI 1902844988
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Trinitycare Hospice

  • Community Based Hospice Care Agency
  • Torrance, CA
  • NPI 1245383165
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1114939394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6069 WOODFERN DR",
            "city": "RANCHO PALOS VERDES",
            "state": "CA",
            "postal_code": "902752263",
            "telephone_number": "310-375-4585",
            "fax_number": "310-375-1735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6069 WOODFERN DR",
            "city": "RANCHO PALOS VERDES",
            "state": "CA",
            "postal_code": "902752263",
            "telephone_number": "310-375-4585",
            "fax_number": "310-375-1735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMATSU",
        "first_name": "GLEN",
        "middle_name": "ISAMU",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "CA",
            "license": "A35086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evan Hyunwu Kim, DDS
• Minseag Kim
• Richard Seongjun Kim, MD
• Mary Nell Kocman
• Harini Delia Koko, AGNP-C
• Nicola Akiko Koyama, P.T.
• Donna Marie Krogh, PHD
• Allan Ku
• Bryce Robert Kubo, DPT
• Greg Kurashige, P.T.

• Pain Medicine Physician in Rancho Palos Verdes, CA
• Providers in Rancho Palos Verdes, CA by specialty
• Pain Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.