Provider Demographics
NPI:1366659104
Name:KOMATSU, KEITH TARO (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:TARO
Last Name:KOMATSU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 S CATALINA AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5516
Mailing Address - Country:US
Mailing Address - Phone:310-375-8012
Mailing Address - Fax:
Practice Address - Street 1:1921 S CATALINA AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5516
Practice Address - Country:US
Practice Address - Phone:310-375-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA404551223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics