Maged Fayez Ibrahim, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

C141296 Issued in CA

Practice address

16465 Sierra Lakes Pkwy
Fontana, CA 92336-1242

Phone

(909) 823-8000

Fax

(909) 823-8088

NPI assigned

Aug 1, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 4

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Dap Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Borrego Springs, CA
  • NPI 1134144165
  NPD
• Golden State Primary Care Inc

  • General Practice Physician
  • Fontana, CA
  • NPI 1124987201

  Pediatrics

  NPD (past)
• Namita Mohideen MD Inc

  • Primary Care Clinic/Center
  • Fontana, CA
  • NPI 1649546144
  NPD (past)

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653350400000",
    "number": "1306852934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6180 CANTABRIA AVE",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917376990",
            "telephone_number": "693-579-6092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16465 SIERRA LAKES PKWY",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923361242",
            "telephone_number": "909-823-8000",
            "fax_number": "909-823-8088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "MAGED",
        "middle_name": "FAYEZ",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301076933",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01071369A",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "C141296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MEMORIALS CHILDRENS HOSPITAL",
            "identifier": "000000778133",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS BMG MAIN STREET",
            "identifier": "000000781460",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201079810",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4376460",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wei Chan Hwang, M.D.
• Byung-Chyul R. Hyun, MD
• Hyung-Ju John Kim DDS Inc
• I Heart LLC
• Diana G Ibarra
• Sherry Mounir Sobhy Ibrahim
• Olujide Ige, BPHARM
• Edward Suk Im, MD
• Imad Akel MD Inc
• Farah Nida Imam, M.D.

• Pediatrics Physician in Fontana, CA
• Providers in Fontana, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2022; 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.