Ibrahim Irawan, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

37119 Issued in CA

Practice address

505 E Arrow Hwy
Glendora, CA 91740-6034

Phone

(626) 335-2899

Fax

(626) 335-3892

NPI assigned

May 7, 2007

Sex

Male

Sole proprietor

Yes

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ibrahim Irawan DDS

  • Dentist
  • Glendora, CA
  • NPI 1093055980
  NPD (past) Authorized official

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083827976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 E ARROW HWY",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917406034",
            "telephone_number": "626-335-2899",
            "fax_number": "626-335-3892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 E ARROW HWY",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917406034",
            "telephone_number": "626-335-2899",
            "fax_number": "626-335-3892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRAWAN",
        "first_name": "IBRAHIM",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "37119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integrated Advanced Medicine Inc
• Integrated Nursing and Rehab Care of Glendora Inc.
• Integrative Urgent Care, Inc. (Integrative Urgent Care)
• Integrity Home Care Services LLC (Homewatch CareGivers of Glendora)
• Intervalley Anesthesia Medical Corporation
• Lisa M Irwin
• Modesty Joy Isaguirre, LE
• Earl Scott Isbell, MD
• Jessica Ishak
• Haley J Isman, RADT

• General Practice Dentistry in Glendora, CA
• Providers in Glendora, 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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.