Kevin Jiro Komatsu, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

42170 Issued in CA

Practice address

10584 W Pico Blvd
Los Angeles, CA 90064-2332

Phone

(310) 837-2000

Fax

(310) 837-7953

NPI assigned

Oct 5, 2007

Sex

Male

Sole proprietor

No

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

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191542400000",
    "number": "1497943237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10584 W PICO BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900642332",
            "telephone_number": "310-837-2000",
            "fax_number": "310-837-7953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10584 W PICO BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900642332",
            "telephone_number": "310-837-2000",
            "fax_number": "310-837-7953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMATSU",
        "first_name": "KEVIN",
        "middle_name": "JIRO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-05",
        "last_updated": "2007-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "42170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kolt Chiropractic Wellness Center Inc
• Angela Kolter, PSY.D.
• Ayaka Marian Komai
• Takeshi Komastsu, ATC., LAC., DAOM
• Emi Jean Fumiko Komatsu, MD
• Abraham Kombajian
• Keiko Komiyama
• Sanath S Kommineni, DDS
• Vivek Kommineni, DPM
• Alexia Komninos, LAC

• General Practice Dentistry in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2007; 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.