Tjahjadi Kusumo-rahardjo is a Anaheim, California based Dentist who is specialized in General Practice Dentistry. He does not accept the Medicare-approved amount. Patients will be billed for the treatment. Active license number of Tjahjadi Kusumo-rahardjo is 49917 for General Practice Dentistry in California. His current practice location is 222 S Emerald St, Anaheim. Patients can reach him at 949-769-0495.
Tjahjadi Kusumo-rahardjo is the primary dental care provider for patients of all ages. He is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Complete Profile:
Tjahjadi Kusumo-rahardjo speciality, credentials, practice address, contact phone number and fax are as below.
Patients can directly walk in or can call on the below given phone number for appointment.
Name:
Tjahjadi Kusumo-rahardjo
Specialization:
Dentist
Gender:
Male
Credentials:
DDS
Accepts Medicare Assignment:
No
Practice Address:
222 S Emerald St, Anaheim, California, 92804-2525
Phone:
949-769-0495
Fax:
714-400-2085
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details are as mentioned below.
NPI Number:
1245366020
NPI Enumeration Date:
26 Feb, 2007
NPI Last Update On:
07 May, 2013
Medical Licenses:
Doctors can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Tjahjadi Kusumo-rahardjo are as mentioned below.
License Number
Specialization
State
Status
49917
General Practice Dentistry
California
Primary
Other Medical Identifiers:
Other legacy medical identifiers associated with Tjahjadi Kusumo-rahardjo such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
Identifier
Type
State
Issuer
D49917
Other
California
DENTIST
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
Address:
222 S Emerald St, Anaheim, California
Zip:
92804-2525
Phone Number:
949-769-0495
Fax Number:
714-400-2085
Patients can reach Tjahjadi Kusumo-rahardjo at 222 S Emerald St, Anaheim, California or can call to book an appointment on 949-769-0495. Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 13 May, 2024.