Andy Kusumo DDS INC
Dentist, General Practice in Anaheim, CA. Organization (NPI-2).
NPI number1255721254
StatusActive
Last updated in NPPESJan 28, 2015
Details
- NPI
- 1255721254
- Entity type
- Organization (NPI-2)
- Legal business name
- Andy Kusumo DDS INC
- Organization subpart
- No
- Enumeration date
- Jan 28, 2015
- Last updated
- Jan 28, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 49917 | CA | Yes |
Practice location
501 N Brookhurst St Ste 100Anaheim, CA 92801-5202
Phone 657-201-3084
Mailing address
222 S Emerald StAnaheim, CA 92804-2525
Phone 949-769-0495
Authorized official
Tjahjadi Andy Kusumo
President
9497690495
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