Healthcare Provider Details

I. General information

NPI: 1609378785
Provider Name (Legal Business Name): EDWIN DUNA BAI MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N TUSTIN AVE STE 182
SANTA ANA CA
92705-3775
US

IV. Provider business mailing address

PO BOX 1074
BREA CA
92822-1074
US

V. Phone/Fax

Practice location:
  • Phone: 714-274-7577
  • Fax:
Mailing address:
  • Phone: 714-686-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number163649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: