Provider Demographics
NPI:1740784982
Name:SIMS-KOMATSU, IRINE (DDS)
Entity Type:Individual
Prefix:
First Name:IRINE
Middle Name:
Last Name:SIMS-KOMATSU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:IRINE
Other - Middle Name:P
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:11980 SAN VICENTE BLVD STE 906
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6607
Mailing Address - Country:US
Mailing Address - Phone:310-207-5900
Mailing Address - Fax:
Practice Address - Street 1:11980 SAN VICENTE BLVD STE 906
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6607
Practice Address - Country:US
Practice Address - Phone:310-207-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice