Provider Demographics
NPI:1346026911
Name:IBRAHIM, PASSANT YOUSSEF (DDS)
Entity Type:Individual
Prefix:
First Name:PASSANT
Middle Name:YOUSSEF
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15785 APPROACH AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-7654
Mailing Address - Country:US
Mailing Address - Phone:626-665-6816
Mailing Address - Fax:
Practice Address - Street 1:11920 GARVEY AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3514
Practice Address - Country:US
Practice Address - Phone:626-988-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist