Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Andy Kusumo DDS Inc

Organization General Practice Dentistry · NPI 1255721254

Andy Kusumo DDS Inc is a General Practice Dentistry in Anaheim, California. Licensed in California. Registered with an NPI since 2015.

Licensed in
CA
In the registry since
2015
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

501 N Brookhurst St Ste 100
Anaheim, CA 92801-5202
Phone: (657) 201-3084
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence 49917 (CA)

Record details

NPI number1255721254
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tjahjadi Kusumo — President · (949) 769-0495
NPI enumeratedJanuary 28, 2015
Last updated in NPPESJanuary 28, 2015
Mailing address222 S Emerald St, Anaheim, CA 92804-2525

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