Provider Demographics
NPI:1497943237
Name:KOMATSU, KEVIN JIRO (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JIRO
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 1:10584 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2332
Mailing Address - Country:US
Mailing Address - Phone:310-837-2000
Mailing Address - Fax:310-837-7953
Practice Address - Street 1:10584 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2332
Practice Address - Country:US
Practice Address - Phone:310-837-2000
Practice Address - Fax:310-837-7953
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA421701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice