Provider Demographics
NPI:1932474079
Name:TAM, MARTIN YUKPOON (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:YUKPOON
Last Name:TAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:866 S 2300 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1430
Mailing Address - Country:US
Mailing Address - Phone:510-384-4075
Mailing Address - Fax:801-331-9826
Practice Address - Street 1:1002 E SOUTH TEMPLE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1525
Practice Address - Country:US
Practice Address - Phone:801-521-2102
Practice Address - Fax:801-521-2830
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT8831907-1205208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology