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DR. TJAHJADI ANDY KUSUMO DDS
NPI 1245366020
Dentist - General Practice in Anaheim, CA

Active since February 26, 2007
501 N BROOKHURST ST STE 100, ANAHEIM, CA 92801(714) 392-8283(888) 498-3823 Get Directions Write a Review

NPPES record last updated: August 15, 2025. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Dr. Tjahjadi Andy Kusumo Dds NPPES

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

DR. TJAHJADI ANDY KUSUMO DDS (NPI 1245366020) is an individual general practice provider in Anaheim, California, licensed in California (49917) and active in the NPI registry since February 2007. He maintains a secondary practice location in Anaheim.

NPPES Registry Identity

NPI1245366020
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameDR. TJAHJADI ANDY KUSUMOCredential: DDS
Location Address501 N BROOKHURST ST STE 100Anaheim, CA 92801-5202
Mailing Address222 S Emerald StAnaheim, CA 92804-2525 · (949) 769-0495 · Fax (714) 400-2085
Phone(714) 392-8283
Fax(888) 498-3823
Sole ProprietorYes
Enumeration DateFebruary 26, 2007
Last NPPES UpdateAugust 15, 2025
NPPES CertifiedAugust 15, 2025
✔ NPI 1245366020 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in CA · 49917
Definition
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.
501 N BROOKHURST ST STE 100, Anaheim, CA 92801
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Other Names 1

Former Name (1)Tjahjadi Kusumo-rahardjo Dds

Secondary Practice Location 1

Location 1222 S Emerald StAnaheim, CA 92804-2525 · Phone (949) 769-0495 · Fax (714) 400-2085

Other Identifiers 1

OtherD49917CA · Dentist

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANDY KUSUMO DDS INC
Dentist (General Practice)
501 N BROOKHURST ST STE 100
ANAHEIM, CA 92801
Orange County (657) 201-3084

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 Tjahjadi Kusumo's NPI number?

The NPI number for Tjahjadi Kusumo is 1245366020. It was assigned to this individual provider in the NPPES registry on February 26, 2007. The provider is also known as Tjahjadi Kusumo-Rahardjo Dds.

Where is Tjahjadi Kusumo located?

Tjahjadi Kusumo practices at 501 N Brookhurst St Ste 100, Anaheim, CA 92801. The listed phone number is (714) 392-8283.

What is Tjahjadi Kusumo's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

What insurance does Tjahjadi Kusumo accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas list Tjahjadi Kusumo as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Tjahjadi Kusumo was last updated on August 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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.