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DR. JACKLYN IBRAHIM
NPI 1699277293
Dentist in Los Angeles, CA

Active since February 28, 2018Opted out of Medicare · through Jun 14, 2028
8405 BEVERLY BLVD, LOS ANGELES, CA 90048(323) 653-1990 Get Directions Write a Review

NPPES record last updated: August 29, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 29, 2019, Feb 28, 2018 (2 updates tracked since 2018).

About Dr. Jacklyn Ibrahim NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACKLYN IBRAHIM (NPI 1699277293) is an individual dentist in Los Angeles, California, licensed in California (104338) and active in the NPI registry since February 2018. She has opted out of Medicare through June 14, 2028 and maintains a secondary practice location in San Jose.

NPPES Registry Identity

NPI1699277293
Entity TypeIndividualFemale
Primary Taxonomy122300000X
Provider Legal NameDR. JACKLYN IBRAHIM
Location Address8405 BEVERLY BLVDLos Angeles, CA 90048-3401
Mailing Address11350 Culver BlvdLos Angeles, CA 90066-6088
Phone(323) 653-1990
Sole ProprietorYes
Enumeration DateFebruary 28, 2018
Last NPPES UpdateAugust 29, 20192 updates tracked since enumeration
✔ NPI 1699277293 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in CA · 104338
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
8405 BEVERLY BLVD, Los Angeles, CA 90048
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Secondary Practice Location 1

Location 155 E Julian StSan Jose, CA 95112-4007 · Phone (408) 280-0672

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Jacklyn Ibrahim has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from June 14, 2022 through June 14, 2028.

Opt-Out Effective DateJune 14, 2022
Opt-Out In Effect ThroughJune 14, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NATALIE ABELLANOSA RN
Registered Nurse
8405 BEVERLY BLVD
LOS ANGELES, CA 90048
Los Angeles County (323) 653-1990
JUSTO SAUL GALICIA RN
Registered Nurse (Community Health)
8405 BEVERLY BLVD
LOS ANGELES, CA 90048
Los Angeles County (323) 653-1990
QUINN VI TANG P.A., L.AC., DACM
Physician Assistant
8405 BEVERLY BLVD
LOS ANGELES, CA 90048
Los Angeles County (323) 653-1990
DEEPTHI DEVIREDDY DDS
Dentist
8405 BEVERLY BLVD
LOS ANGELES, CA 90048
Los Angeles County (323) 653-1990
JANKI THAKORBHAI PATEL
Pharmacist
8405 BEVERLY BLVD
LOS ANGELES, CA 90048
Los Angeles County (323) 653-1990
TARA ABRAMS NP
Nurse Practitioner (Acute Care)
8405 BEVERLY BLVD
LOS ANGELES, CA 90048
Los Angeles County (562) 335-7332
JOCELYNN MARIE ORTEGA-GONZALEZ D.M.D
Dentist
8405 BEVERLY BLVD
LOS ANGELES, CA 90048
Los Angeles County (323) 653-8622
DR. VALERIE S THADHANI MD
Internal Medicine
8405 BEVERLY BLVD
LOS ANGELES, CA 90048
Los Angeles County (323) 653-1990

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacklyn Ibrahim's NPI number?

The NPI number for Jacklyn Ibrahim is 1699277293. It was assigned to this individual provider in the NPPES registry on February 28, 2018.

Where is Jacklyn Ibrahim located?

Jacklyn Ibrahim practices at 8405 Beverly Blvd, Los Angeles, CA 90048. The listed phone number is (323) 653-1990.

What is Jacklyn Ibrahim's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Jacklyn Ibrahim enrolled in Medicare?

No. Jacklyn Ibrahim has opted out of Medicare through June 14, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Jacklyn Ibrahim was last updated on August 29, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.