Provider Demographics
NPI:1063094142
Name:KOMATSU, EMI JEAN FUMIKO (MD)
Entity type:Individual
Prefix:
First Name:EMI
Middle Name:JEAN FUMIKO
Last Name:KOMATSU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6069 WOODFERN DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-2263
Mailing Address - Country:US
Mailing Address - Phone:310-872-0301
Mailing Address - Fax:
Practice Address - Street 1:1200 NORTH STATE STREET
Practice Address - Street 2:IPT C3F107
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1029
Practice Address - Country:US
Practice Address - Phone:310-872-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program