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 |
Frequently asked questions
What is Dr. Tjahjadi Kusumo's medical specialty?
Dr. Tjahjadi Kusumo practices General Practice Dentistry in Anaheim, CA.
Where does Dr. Tjahjadi Kusumo practice?
Dr. Tjahjadi Kusumo practices at 501 N Brookhurst St Ste 100, Anaheim, CA 928015202. Office phone: 7143928283.
What is Dr. Tjahjadi Kusumo's NPI?
Dr. Tjahjadi Kusumo's National Provider Identifier (NPI) is 1245366020, issued by NPPES.