Provider Demographics
NPI:1144619297
Name:BAHIA, MUSA
Entity Type:Individual
Prefix:
First Name:MUSA
Middle Name:
Last Name:BAHIA
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 1:9070 IRVINE CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4678
Mailing Address - Country:US
Mailing Address - Phone:949-635-1700
Mailing Address - Fax:
Practice Address - Street 1:9070 IRVINE CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4678
Practice Address - Country:US
Practice Address - Phone:949-635-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49276122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist