Provider Demographics
NPI:1750549424
Name:KOKKONEN, JEREMY JUHANI (DO)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:JUHANI
Last Name:KOKKONEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 WOODSTEAD CT
Mailing Address - Street 2:STE 208
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1480
Mailing Address - Country:US
Mailing Address - Phone:877-749-7428
Mailing Address - Fax:512-628-3314
Practice Address - Street 1:620 SHADOW LANE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4194
Practice Address - Country:US
Practice Address - Phone:702-388-4000
Practice Address - Fax:702-388-8431
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY11025A208100000X
SL0518174400000X
AZ007204208100000X
HIDO-1245193200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No174400000XOther Service ProvidersSpecialist
No193200000XGroupMulti-SpecialtyGroup - Single Specialty