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1811037435
KUSUMO SUMARDI
LA VERNE, CA
NPI
1811037435
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1223G0001X Dentist, General Practice
(Licence: CA 41680)
Enumeration Date
2007-02-06
Last Update Date
2007-07-08
Business Address
-- KUSUMO SUMARDI D.D.S.
1965 FOOTHILL BLVD SUITE L
LA VERNE, CA 91750-3502
Phone number: 909-596-6500
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Mailing Address
-- KUSUMO SUMARDI D.D.S.
3870 GRAND AVE
CLAREMONT, CA 91711-1454
Phone number: 909-621-9088
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