Healthcare Provider Details

I. General information

NPI: 1114957628
Provider Name (Legal Business Name): TONY YUK MAN TAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COFFEE RD
MODESTO CA
95355-2803
US

IV. Provider business mailing address

4490 OAKDALE RD
MODESTO CA
95357-0800
US

V. Phone/Fax

Practice location:
  • Phone: 209-579-5628
  • Fax: 209-579-5637
Mailing address:
  • Phone: 209-404-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberG71710
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG71710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: