MEDICARE: JEREMY JUHANI KOKKONEN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	11025A	WY
2	174400000X	Specialist	SL0518
3	208100000X	Physical Medicine & Rehabilitation Physician	007204	AZ
4	193200000X	Multi-Specialty Group	DO-1245	HI

General Provider Information

NPI Number	:	1750549424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY JUHANI KOKKONEN DO

Provider Business Mailing Address
First Line	:	1776 WOODSTEAD CT
Second Line	:	STE 208
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-1480
Country	:	US
Telephone Number	:	877-749-7428
Fax Number	:	512-628-3314

Provider Business Practice Location Address
First Line	:	620 SHADOW LANE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4194
Country	:	US
Telephone Number	:	702-388-4000
Fax Number	:	702-388-8431

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	04/14/2023

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