Provider Demographics
NPI:1114957628
Name:TAM, TONY YUK MAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:YUK MAN
Last Name:TAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4490 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-0800
Mailing Address - Country:US
Mailing Address - Phone:209-404-2261
Mailing Address - Fax:
Practice Address - Street 1:1700 COFFEE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2803
Practice Address - Country:US
Practice Address - Phone:209-579-5628
Practice Address - Fax:209-579-5637
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG717102086S0127X, 208600000X, 2086S0129X, 208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G717100Medicaid
00G717102OtherPROVIDER TRANSACTION ACCESS NUMBER (PTAN)
CAG717100Medicare UPIN
CA00G717100Medicaid