Individual provider · Type 1 NPI

Tjahjadi Andy Kusumo, DDS

General Practice Dentistry · Anaheim, CA

NPI number 1245366020 Active

Practice location

501 N Brookhurst St Ste 100
Anaheim, CA 92801-5202

Call (714) 392-8283 Map

Fax (888) 498-3823

Mailing address

222 S Emerald St
Anaheim, CA 92804-2525

Other practice locations

  • 222 S Emerald St, Anaheim, CA 92804-2525 · (949) 769-0495

Specialties and licenses

TaxonomyCodeLicense
General Practice Dentistry Primary 1223G0001X49917 (CA)

General Practice Dentistry: A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

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About NPI 1245366020

Tjahjadi Andy Kusumo, DDS's National Provider Identifier is 1245366020, issued on Feb 26, 2007. The primary taxonomy on file is General Practice Dentistry (1223G0001X), and the practice location is in Anaheim, CA. The record was last updated on Aug 15, 2025.