Organization
ANDY KUSUMO DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TJAHJADI ANDY KUSUMO DDS (PRESIDENT)
(949) 769-0495
Entity
Organization
Contact information
Practice address
501 N BROOKHURST ST STE 100, ANAHEIM, CA 92801-5202
(657) 201-3084
Mailing address
222 S EMERALD ST, ANAHEIM, CA 92804-2525
(949) 769-0495
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
49917
CA
Other
Enumeration date
01/28/2015
Last updated
01/28/2015
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