Provider Demographics
NPI:1982737060
Name:SILIM, KEO TANG
Entity Type:Individual
Prefix:MISS
First Name:KEO
Middle Name:TANG
Last Name:SILIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E HACKETT RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-9800
Mailing Address - Country:US
Mailing Address - Phone:209-558-3575
Mailing Address - Fax:209-558-1075
Practice Address - Street 1:251 E. HACKETT
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1596
Practice Address - Country:US
Practice Address - Phone:209-558-3575
Practice Address - Fax:209-558-1075
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator