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KRISTINA AKEMI KOMORI
NPI 1164871083
Marriage & Family Therapist in Fullerton, CA

Active since June 10, 2016PECOS EnrolledAccepts Medicare Assignment
1530 W OLIVE AVE, FULLERTON, CA 92833(714) 766-9771 Get Directions Write a Review

NPPES record last updated: November 1, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Kristina Akemi Komori NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KRISTINA AKEMI KOMORI (NPI 1164871083) is an individual marriage & family therapist in Fullerton, California, licensed in California (132718) and active in the NPI registry since June 2016. She is enrolled in Medicare PECOS and is a graduate of Other (2017).

NPPES Registry Identity

NPI1164871083
Entity TypeIndividualFemale
Primary Taxonomy106H00000X
Provider Legal NameKRISTINA AKEMI KOMORI
Location Address1530 W OLIVE AVEFullerton, CA 92833-3954
Mailing Address1530 W Olive AveFullerton, CA 92833-3954
Phone(714) 766-9771
Sole ProprietorNo
Medical School CMSOtherGraduated 2017
Enumeration DateJune 10, 2016
Last NPPES UpdateNovember 1, 2024
NPPES CertifiedNovember 1, 2024
✔ NPI 1164871083 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers
Taxonomy Code106H00000X
License✔ Licensed in CA · 132718
Definition
A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
1530 W OLIVE AVE, Fullerton, CA 92833
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kristina Akemi Komori is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6709381403
PECOS Enrollment IDI20250924001922
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kristina Komori reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Southern California Permanente Medical Group
1.0 mi
Health Maintenance Organization
1893 W MALVERN AVE
Fullerton, CA 92833
  • Reassigned Medicare billing, California enrollment
  • 13,921 clinicians in this Medicare group
NPI 1336556059 (877) 608-0044

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kristina Komori's NPI number?

The NPI number for Kristina Komori is 1164871083. It was assigned to this individual provider in the NPPES registry on June 10, 2016.

Where is Kristina Komori located?

Kristina Komori practices at 1530 W Olive Ave, Fullerton, CA 92833. The listed phone number is (714) 766-9771.

What is Kristina Komori's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Is Kristina Komori enrolled in Medicare?

Yes. Kristina Komori is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Kristina Komori's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kristina Komori reassigns Medicare benefits to Southern California Permanente Medical Group (Fullerton, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kristina Komori's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kristina Komori was last updated on November 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.