Keith Taro Komatsu, D.D.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

40455 Issued in CA

Practice address

1921 S Catalina Ave
Suite 3
Redondo Beach, CA 90277-5516

Phone

(310) 375-8012

NPI assigned

May 17, 2007

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Keith T Komatsu DDS Apc

  • Endodontics
  • Redondo Beach, CA
  • NPI 1548837198
  NPD Authorized official

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1366659104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 S CATALINA AVE",
            "address_2": "SUITE 3",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902775516",
            "telephone_number": "310-375-8012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 S CATALINA AVE",
            "address_2": "SUITE 3",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902775516",
            "telephone_number": "310-375-8012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMATSU",
        "first_name": "KEITH",
        "middle_name": "TARO",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "40455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Russell Paul Knittel, MD
• Annie Ko, DDS
• Yumiko Kodama, LCSW
• Joshua Kohansamad, AMFT, APCC
• Alison Kole, DO
• Stacy Korfist, LMFT
• Adrian Julian Korol, DC
• Kyle Koshimizu
• Kavitha S Kotrappa, M.D.
• Bobby Kou, OTD

• Endodontics in Redondo Beach, CA
• Providers in Redondo Beach, CA by specialty
• Endodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.