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

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1619461696

Faiz Endro Kusumo, MD is a Diagnostic Radiology in Fresno, California. Graduated from University of Southern California Keck School of Medicine in 2018, 8 years ago. Practices with Permanente Medical Group Inc, a 10,941-clinician group and accepts Medicare assignment.

Years since qualifying
8
Trained at
University of Southern California Keck School of Medicine
In the registry since
2018
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1313 E Herndon Ave
Fresno, CA 93720-3306
Phone: (559) 450-5375
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1619461696
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 21, 2018
Last updated in NPPESJune 21, 2018
Mailing address1313 E Herndon Ave, Fresno, CA 93720-3306

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolUNIVERSITY OF SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE
Graduated 2018 (8 years in practice)
Group practice Permanente Medical Group Inc — 10941 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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