Chris Ibrahim, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

104458 Issued in CA

Practice address

22142 Sherman Way Ste 201
Canoga Park, CA 91303-1136

Phone

(818) 703-8200

NPI assigned

Apr 20, 2016

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

Medicare fee-for-service enrollment

Enrolled in LA

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

State licenses

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.

• Heritage Oral Surgery and Implant Centers

  • Oral and Maxillofacial Surgery (Dentist)
  • Valencia, CA
  • NPI 1205479391
  NPD (past)

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

{
    "created_epoch": "1461110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767916800000",
    "number": "1679927131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11838 SHOSHONE AVE",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913442228",
            "telephone_number": "818-688-1686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22142 SHERMAN WAY STE 201",
            "city": "CANOGA PARK",
            "state": "CA",
            "postal_code": "913031136",
            "telephone_number": "818-703-8200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4620 S McColl Rd",
            "address_purpose": "LOCATION",
            "city": "Edinburg",
            "state": "TX",
            "postal_code": "785396989",
            "country_code": "US",
            "telephone_number": "956-696-4385",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "27450 Tourney Rd Ste 160",
            "address_purpose": "LOCATION",
            "city": "Valencia",
            "state": "CA",
            "postal_code": "913551863",
            "country_code": "US",
            "telephone_number": "661-253-3500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "CHRIS",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-20",
        "last_updated": "2026-01-09",
        "certification_date": "2026-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "104458",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "38349",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CO",
            "license": "DEN.00205493",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Canoga Park, CA
• Providers in Canoga Park, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2026; 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.