| Andy Kusumo Dds Inc | |
|
501 N Brookhurst St Ste 100 Anaheim CA 92801-5202 | |
| (657) 201-3084 | |
| Not Available |
| Full Name | Andy Kusumo Dds Inc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 501 N Brookhurst St Ste 100, Anaheim, California |
| Authorized Official Name and Position | Tjahjadi Andy Kusumo (PRESIDENT) |
| Authorized Official Contact | 9497690495 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Andy Kusumo Dds Inc 222 S Emerald St Anaheim CA 92804-2525 Ph: (949) 769-0495 | Andy Kusumo Dds Inc 501 N Brookhurst St Ste 100 Anaheim CA 92801-5202 Ph: (657) 201-3084 |
| NPI Number | 1255721254 |
|---|---|
| Provider Enumeration Date | 01/28/2015 |
| Last Update Date | 01/28/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255721254 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 49917 (California) | Primary |
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