Thomas Sudibjo, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

45983 Issued in CA

Practice address

1096 Irvine Blvd
Tustin, CA 92780-3527

Phone

(714) 838-6777

Fax

(714) 838-8277

NPI assigned

Feb 5, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786060800000",
    "number": "1891834099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1096 IRVINE BLVD",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803527",
            "telephone_number": "714-838-6777",
            "fax_number": "714-838-8277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1096 IRVINE BLVD",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803527",
            "telephone_number": "714-838-6777",
            "fax_number": "714-838-8277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDIBJO",
        "first_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2026-08-07",
        "certification_date": "2026-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "45983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suzanne Stubblefield, PH.D.
• Marissa Sturges, DC
• David Austin Su
• Stephanie Suarez
• Surabi Subramanian, DDS
• Yojiro Sudo, DC
• Breanne Nicole Suguitan
• Eunice Suh, NP
• Chizuru Maruyama Sukauskas
• Summit Acupuncture & Herbs

• General Practice Dentistry in Tustin, CA
• Providers in Tustin, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.