Healthcare Provider Details

I. General information

NPI: 1225539422
Provider Name (Legal Business Name): JOHNNA TANJI AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 12/13/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JOSE FIGUERES AVE STE 280
SAN JOSE CA
95116-1555
US

IV. Provider business mailing address

2010 EL CAMINO REAL STE 723
SANTA CLARA CA
95050-4051
US

V. Phone/Fax

Practice location:
  • Phone: 408-937-8900
  • Fax:
Mailing address:
  • Phone: 808-348-6860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberAU3316
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU3316
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU3316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: