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General NPI Number Information
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NPI Number | 1780100958
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Entity Type | Individual
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Provider Name | KODJOVI DINYEFAN KODJO MD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2017
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 915 HIGHLAND BLVD
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City | BOZEMAN
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State | MT
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Zip | 59715-6902
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Country | US
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Telephone | 406-414-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 915 HIGHLAND BLVD
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City | BOZEMAN
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State | MT
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Zip | 59715-6902
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Country | US
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Telephone | 406-414-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | CDR.0004311
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 91977
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20166
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License Number State | ND
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | CDR.0004311
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License Number State | CO
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 218873
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License Number State | AK
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 65845
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License Number State | TN
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101268565
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License Number State | VA
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Taxonomy #8
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 73990
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License Number State | MN
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Taxonomy #9
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD213412
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License Number State | OR
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Taxonomy #10
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MED-PHYS-LIC-118481
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License Number State | MT
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