# GLEN I KOMATSU M D A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROVIDENCE HEALTH AND SERVICES
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1073734778
- **Legal business name:** PROVIDENCE HEALTH AND SERVICES
- **Authorized official:** GLEN I KOMATSU MD (OWNER)
- **Authorized official phone:** (310) 375-4585

## Contact information

- **Practice address:** 4101 TORRANCE BLVD, PALLIATIVE CARE, TORRANCE, CA 90503-4607
- **Practice address phone:** (310) 303-6840
- **Practice address fax:** (310) 303-5574
- **Mailing address:** 6069 WOODFERN DR, RANCHO PALOS VERDES, CA 90275-2263
- **Mailing address phone:** (310) 545-9713
- **Mailing address fax:** (310) 546-1648

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/01/2007
- **Last updated:** 09/07/2023