Active NPI
Kaziwa Omer Ibrahim, DDS
- General Practice Dentistry
- Aurora, CO
National Provider Identifier
1285129403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DEN.00203657
- Practice address
- 16486 E Radcliff PL Apt B
Aurora, CO 80015-7144 - Phone
- (719) 761-5397
- NPI assigned
- Jun 29, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DEN.00203657 | CO | Primary |
Addresses
Primary practice location
16486 E Radcliff PL Apt B
Aurora, CO 80015-7144
Mailing address
16486 E Radcliff PL Apt B
Aurora, CO 80015-7144
Phone (719) 761-5397
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220721001492 | WA | Order and Referring Only - Dentist | 9537540562 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEN.00203657 | CO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530230400000",
"number": "1285129403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16486 E RADCLIFF PL APT B",
"city": "AURORA",
"state": "CO",
"postal_code": "800157144",
"telephone_number": "719-761-5397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16486 E RADCLIFF PL APT B",
"city": "AURORA",
"state": "CO",
"postal_code": "800157144",
"telephone_number": "719-761-5397"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBRAHIM",
"first_name": "KAZIWA",
"middle_name": "OMER",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-06-29",
"last_updated": "2018-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "DEN.00203657",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aurora, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2018; 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.