Provider Demographics
NPI:1639319478
Name:TANHA, REZA (DC)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:TANHA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 MERIDIAN AVE
Mailing Address - Street 2:2
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2927
Mailing Address - Country:US
Mailing Address - Phone:408-295-1239
Mailing Address - Fax:408-715-0303
Practice Address - Street 1:240 MERIDIAN AVE
Practice Address - Street 2:2
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126
Practice Address - Country:US
Practice Address - Phone:408-295-1239
Practice Address - Fax:408-715-0303
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 23126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor