Doctor profile · Federal record
Dr. TJAHJADI KUSUMO, DDS
General Practice Dentistry · ANAHEIM, CA
- NPI 1245366020
- 19 yrs on file
- Male
- Solo practice
- No sanctions
Practice & contact
Operates at 2 locations .
- Primary practice
-
501 N BROOKHURST ST STE 100
ANAHEIM, CA 928015202
(714) 392-8283
fax (888) 498-3823 - Additional location
-
222 S Emerald St
Anaheim, CA 928042525
(949) 769-0495
fax (714) 400-2085 - Mailing address
-
222 S EMERALD ST
ANAHEIM, CA 928042525
Credentials & registration
- NPI registered
- February 2007 — 19 yrs on file
- Profile last updated
- August 15, 2025
- Specialty taxonomy
- 1223G0001X — NUCC code
- State license (1)
- California #49917
Federal sanctions & exclusions
No sanctions, exclusions or revocations on file
Checked against OIG LEIE on NPI 1245366020. Last verified May 11, 2026.Open Payments
Industry payments received
All-time total
$98
Transactions
3
Manufacturers
2
| Payer (manufacturer) | Industry | Txns | Amount |
|---|---|---|---|
| PATTERSON COMPANIES, INC. | 2 | $76.86 | |
| Dentsply Sirona Inc | 1 | $20.80 |
By nature of payment
Medicare Part D · 2023
Top prescriptions
Total claims
117
Patients
61
Total drug cost
$528
| Drug | Type | Claims | Patients | Total cost |
|---|---|---|---|---|
| Amoxicillin | Generic | 69 | 37 | $280 |
| Ibuprofen | Generic | 36 | 24 | $128 |
| Clindamycin Hcl | Generic | 12 | 0 | $119 |