Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G71710 | CA |
Y | 208600000X | Surgeon | G71710 | CA |
N | 2086S0102X | Surgical Critical Care | G71710 | CA |
N | 2086S0127X | Trauma Surgeon | G71710 | CA |
N | 2086S0129X | Vascular Surgeon | G71710 | CA |
N | 208C00000X | Colorectal Surgeon | G71710 | CA |
NPI | 1114957628 |
---|---|
Provider Name | Dr. Tony Yuk Man Tam |
First Address | Modesto, CA 95350-1159 |
Second Address | Modesto, CA 95355-2803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 20/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G717100 | (05) | CA |
00G717102 | PROVIDER TRANSACTION ACCESS NUMBER (PTAN) (01) | |
G717100 | (02) | CA |