Provider Demographics
NPI:1700757127
Name:KUA, DUSTIN AVERY
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:AVERY
Last Name:KUA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21380 CENTRE POINTE PKWY
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-3050
Mailing Address - Country:US
Mailing Address - Phone:661-259-0033
Mailing Address - Fax:
Practice Address - Street 1:31575 VALLEY CREEK RD
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384-5500
Practice Address - Country:US
Practice Address - Phone:661-888-6288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA151912101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health