MEDICARE: DR. TAKESHI KOMASTSU ATC., LAC., DAOM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	7799	CA

General Provider Information

NPI Number	:	1154423093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAKESHI KOMASTSU ATC., LAC., DAOM

Provider Business Mailing Address
First Line	:	11340 W OLYMPIC BLVD
Second Line	:	SUITE340
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1608
Country	:	US
Telephone Number	:	310-991-0729
Fax Number	:

Provider Business Practice Location Address
First Line	:	11340 W OLYMPIC BLVD
Second Line	:	SUITE340
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1608
Country	:	US
Telephone Number	:	310-991-0729
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	01/30/2008

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Directions to “ DR. TAKESHI KOMASTSU ATC., LAC., DAOM” Practice Location

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