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: July 19, 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
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

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

Other Providers at the Same Location NPPES

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

Dentist (General Practice)
501 N BROOKHURST ST STE 100
ANAHEIM, CA 92801

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1245366020, enumerated as an "individual" on February 26, 2007.

The provider is located at 501 N BROOKHURST ST STE 100 ANAHEIM, CA 92801 and the phone number is (714) 392-8283.

Dentist with taxonomy code 1223G0001X and a focus in General Practice.

The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield, Blue Cross and. Please consult your insurance carrier or call the provider to verify.