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Tjahjadi Kusumo-rahardjo, DDS
General Practice Dentistry in Anaheim, California
NPI 1245366020

Tjahjadi Kusumo-rahardjo is a General Practice Dentistry based in Anaheim, CA and is specialized in General Practice. Tjahjadi Kusumo-rahardjo practices in Anaheim, CA and has the professional credentials of DDS. The NPI Number for Tjahjadi Kusumo-rahardjo is 1245366020 and holds a License No. 49917 (California).

The current practice location address for Tjahjadi Kusumo-rahardjo is 222 S Emerald St, Anaheim, CA and can be reached out via phone at 949-769-0495 and via fax at 714-400-2085.

Location: 222 S Emerald St, Anaheim, CA, 92804-2525
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1245366020
Provider Name
Tjahjadi Kusumo-rahardjo
Credential
DDS
Provider Entity Type
Individual
Gender
Male
Address
222 S Emerald St, Anaheim, CA, 92804-2525
Phone Number
949-769-0495
Fax Number
714-400-2085
Provider Enumeration Date
02/26/2007
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
D49917 01 CA DENTIST
institution
Provider Business Practice Location Address Details
Address
222 S Emerald St
City
Anaheim
State
California
Zip
92804-2525
Phone Number
949-769-0495
Fax Number
714-400-2085
person
Provider Business Mailing Address Details
Address
222 S Emerald St
City
Anaheim
State
California
Zip
92804-2525
Phone Number
949-769-0495
Fax Number
714-400-2085
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
General Practice
Taxonomy
1223G0001X
License No.
49917 (California)
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
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