Healthcare Provider Details

I. General information

NPI: 1700757127
Provider Name (Legal Business Name): DUSTIN AVERY KUA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31575 VALLEY CREEK RD
CASTAIC CA
91384-5500
US

IV. Provider business mailing address

21380 CENTRE POINTE PKWY
SANTA CLARITA CA
91350-3050
US

V. Phone/Fax

Practice location:
  • Phone: 661-888-6288
  • Fax:
Mailing address:
  • Phone: 661-259-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number151912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: