Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Tjahjadi Andy Kusumo, DDS

Individual provider General Practice Dentistry · NPI 1245366020

Dr. Tjahjadi Andy Kusumo, DDS is a General Practice Dentistry in Anaheim, California. Practices as a sole proprietor and works from 2 locations. Licensed in California.

Licensed in
CA
In the registry since
2007
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.

See every abbreviation used in this directory →

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Practice location Address checks out

501 N Brookhurst St Ste 100
Anaheim, CA 92801-5202
Phone: (714) 392-8283
Fax: (888) 498-3823
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

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

Specialties & licences

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

Record details

NPI number1245366020
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS
Sole proprietorYes
NPI enumeratedFebruary 26, 2007
Last updated in NPPESAugust 15, 2025
Certification dateAugust 15, 2025

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