Tjahjadi Andy Kusumo
ActiveCalifornia license 49917
License
- Licensed by
- Dental Board of California
- License number
- 49917
- Status
- Active (Current)
- First issued
- August 20, 2002
- Expires
- July 31, 2027
- License holder
- Tjahjadi Andy Kusumo
- Entity type
- Individual
Classifications
- Dental License Dental
More from the license record
- License type code
- 4401
Contact
501 N Brookhurst St Ste 100
Anaheim, CA 92801-5202
Anaheim, CA 92801-5202
Orange County