OrganizationActive
Andy Kusumo DDS Inc
NPI 1255721254 · General Practice Dentistry · Anaheim, CA
Andy Kusumo DDS Inc is a General Practice Dentistry organization in Anaheim, CA (NPI 1255721254).
Provider details
- NPI number
- 1255721254
- Entity type
- Organization
- Primary specialty
- General Practice DentistryDental Providers
- Organization subpart
- No
- Authorized official
- Tjahjadi Kusumo, President(949) 769-0495
- License
- 49917 (CA)
Specialties & taxonomies
Dental Providers
Profile Score
Established profile(74/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
11 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
501 N Brookhurst St Ste 100
Anaheim, CA 92801-5202
Phone: (657) 201-3084
Street-level locationGet directions
Mailing address
222 S Emerald St
Anaheim, CA 92804-2525
Registry dates
- Enumerated
- 2015-01-28
- Last updated
- 2015-01-28
Frequently asked questions
- What is Andy Kusumo DDS Inc's NPI number?
- Andy Kusumo DDS Inc's National Provider Identifier (NPI) is 1255721254, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Andy Kusumo DDS Inc?
- Andy Kusumo DDS Inc is classified in the NPPES registry as General Practice Dentistry (Dental Providers).
- Where is Andy Kusumo DDS Inc located?
- Andy Kusumo DDS Inc's practice location on file with NPPES is 501 N Brookhurst St Ste 100, Anaheim, CA 92801-5202.
- What is Andy Kusumo DDS Inc's phone number?
- The practice phone number listed in the NPPES registry for Andy Kusumo DDS Inc is (657) 201-3084.
- Who is the authorized official for Andy Kusumo DDS Inc?
- The authorized official listed on Andy Kusumo DDS Inc's NPPES record is Tjahjadi Kusumo, President. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Andy Kusumo DDS Inc's NPI active?
- Yes — Andy Kusumo DDS Inc's NPI (1255721254) is active in the NPPES registry as of the last update on 2015-01-28.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.