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ANDY KUSUMO DDS INC
NPI 1255721254
Dentist - General Practice in Anaheim, CA

Active since January 28, 2015
501 N BROOKHURST ST STE 100, ANAHEIM, CA 92801(657) 201-3084 Get Directions Write a Review

NPPES record last updated: January 28, 2015. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Andy Kusumo Dds Inc NPPES

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

ANDY KUSUMO DDS INC (NPI 1255721254) is a healthcare organization registered as a general practice in Anaheim, California and active in the NPI registry since January 2015. The organization lists Tjahjadi Andy Kusumo, President, as its authorized official.

NPPES Registry Identity

NPI1255721254
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameANDY KUSUMO DDS INC
Location Address501 N BROOKHURST ST STE 100Anaheim, CA 92801-5202
Mailing Address222 S Emerald StAnaheim, CA 92804-2525 · (949) 769-0495
Phone(657) 201-3084
Organization SubpartNo
Authorized OfficialTjahjadi Andy KusumoPresident · (949) 769-0495
Enumeration DateJanuary 28, 2015
✔ NPI 1255721254 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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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

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

DR. TJAHJADI ANDY KUSUMO DDS
Dentist (General Practice)
501 N BROOKHURST ST STE 100
ANAHEIM, CA 92801
Orange County (714) 392-8283

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 Andy Kusumo Dds Inc's NPI number?

The NPI number for Andy Kusumo Dds Inc is 1255721254. It was assigned to this organization in the NPPES registry on January 28, 2015.

Where is Andy Kusumo Dds Inc located?

Andy Kusumo Dds Inc is located at 501 N Brookhurst St Ste 100, Anaheim, CA 92801. The listed phone number is (657) 201-3084.

What is Andy Kusumo Dds Inc's specialty?

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

When was this NPI record last updated?

The NPPES record for Andy Kusumo Dds Inc was last updated on January 28, 2015. NPI Profile syncs with the weekly NPPES data releases published by CMS.