Active NPI
George Eyad Ibrahim, DDS
- Dentist
- Berkeley, CA
National Provider Identifier
1093497463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 109016
- Practice address
- 1760 Solano Ave Ste 309
Berkeley, CA 94707-2218 - Phone
- (510) 527-9564
- NPI assigned
- Aug 3, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 109016 | CA | Primary |
Addresses
Primary practice location
1760 Solano Ave Ste 309
Berkeley, CA 94707-2218
Mailing address
2242 Kenry Way
S San Fran, CA 94080-5508
Phone (650) 773-3411
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109016 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| George Ibrahim DDS, Inc | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- South San Francisco, CA
- NPI 1518756253
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691020800000",
"number": "1093497463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2242 KENRY WAY",
"city": "S SAN FRAN",
"state": "CA",
"postal_code": "940805508",
"telephone_number": "650-773-3411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1760 SOLANO AVE STE 309",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947072218",
"telephone_number": "510-527-9564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBRAHIM",
"first_name": "GEORGE",
"middle_name": "EYAD",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-03",
"last_updated": "2023-08-03",
"certification_date": "2023-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "109016",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.