Active NPI
Kodjovi Dinyefan Kodjo, MD
- Psychiatry Physician
- Bozeman, MT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MED-PHYS-LIC-118481
- Practice address
- 915 Highland Blvd
Bozeman, MT 59715-6902 - Phone
- (406) 414-5000
- NPI assigned
- Aug 18, 2017
- Last updated
- Jun 29, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 11
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 0101268565 | VA | |
| Psychiatry Physician | 2084P0800X | 91977 | GA | |
| Psychiatry Physician | 2084P0800X | MED-PHYS-LIC-118481 | MT | Primary |
| Psychiatry Physician | 2084P0800X | MD213412 | OR | |
| Psychiatry Physician | 2084P0800X | CDR.0004311 | CO | |
| Psychiatry Physician | 2084P0800X | 65845 | TN | |
| Psychiatry Physician | 2084P0800X | 20166 | ND | |
| Psychiatry Physician | 2084P0800X | 04-47333 | KS | |
| Psychiatry Physician | 2084P0800X | 218873 | AK | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | CDR.0004311 | CO | |
| Psychiatry Physician | 2084P0800X | 73990 | MN |
Addresses
Primary practice location
915 Highland Blvd
Bozeman, MT 59715-6902
Mailing address
915 Highland Blvd
Bozeman, MT 59715-6902
Phone (406) 414-5000
Other practice location 1
4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522
Phone (612) 262-1220
Other practice location 2
2000 Brookside Dr
Kingsport, TN 37660-4627
Phone (423) 857-7000
Other practice location 3
3333 Riverbend Dr
Springfield, OR 97477-8800
Phone (541) 222-2185
Other practice location 4
1515 Village Dr
Cottage Grove, OR 97424-9700
Phone (458) 205-6555
Other practice location 5
1990 Holton Ave E
Big Stone Gap, VA 24219-3350
Phone (276) 523-3111
Other practice location 6
1 Medical Park Blvd
Bristol, TN 37620-7430
Phone (423) 844-1121
Other practice location 7
400 N State Of Franklin Rd
Johnson City, TN 37604-6035
Phone (423) 431-6111
Other practice location 8
851 Locust St
Rogersville, TN 37857-2407
Phone (423) 921-7000
Other practice location 9
400 9th St
Florence, OR 97439-7398
Phone (458) 205-6555
Other practice location 10
1500 Commonwealth Ave
Williamsburg, VA 23185-5229
Phone (757) 585-2250
Other practice location 11
1020 First Colonial Rd Ste A
Virginia Beach, VA 23454-3078
Phone (757) 395-1850
Other practice location 12
11600 W 2nd Pl
Lakewood, CO 80228-1527
Phone (720) 321-0000
Other practice location 13
1501 W Elk Ave
Elizabethton, TN 37643-2874
Phone (423) 542-1300
Other practice location 14
2030 Temple Hill Rd
Erwin, TN 37650-8721
Phone (423) 743-3141
Other practice location 15
130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 224-4000
Other practice location 16
3100 Tongass Ave
Ketchikan, AK 99901-5746
Phone (907) 228-7660
Other practice location 17
16000 Johnston Memorial Dr
Abingdon, VA 24211-7664
Phone (276) 258-1000
Other practice location 18
2017 Jefferson St SW
Roanoke, VA 24014-2419
Phone (540) 981-8025
Other practice location 19
401 E Spruce St
Garden City, KS 67846-5679
Phone (303) 673-7531
Other practice location 20
1519 Main St
Sneedville, TN 37869-3657
Phone (423) 733-5000
Other practice location 21
1420 Tusculum Blvd
Greeneville, TN 37745-4279
Phone (423) 787-5000
Other practice location 22
1901 S Shady St
Mountain City, TN 37683-2021
Phone (423) 727-1100
Other practice location 23
245 Medical Park Dr
Marion, VA 24354-1100
Phone (276) 378-1000
Other practice location 24
58 Carroll Street
Lebanon, VA 24266-4510
Phone (276) 883-8000
Other practice location 25
312 Hospital Dr
Clintwood, VA 24228-6786
Phone (276) 926-0300
Other practice location 26
300 Med Tech Pkwy
Johnson City, TN 37604-2277
Phone (423) 302-1000
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kkodjo628231@excellian.direct.allina.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA, FL, GA, NC, TN, NJ, MI, MN, OR, WA, MO, PA, MT, WV, WY, AK, NY, CO, WI, ND, TX, CA, UT, KS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 24
Care Compare profile
Medicare Care Compare- Specialty
- Psychiatry
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- PeacehealthAllina Health System
Practice addresses (Care Compare)
Tampa, FL 33617
Phone (570) 271-6144
San Antonio, TX 78253
Phone (541) 222-2185
1000 Nut Tree Rd
Vacaville, CA 95687-4100
Phone (844) 496-9160
1015 NW 22ND Ave
Portland, OR 97210-3025
Phone (503) 413-7711
1080 1St Colonial Rd
Suite 403
Virginia Beach, VA 23454-2406
Phone (757) 395-1850
11600 W 2ND PL
Sah Behavioral Health
Lakewood, CO 80228-1527
Phone (720) 321-0000
1200 7TH Ave N
St Petersburg, FL 33705-1300
Phone (727) 532-1355
1240 Huffman Mill Rd
Burlington, NC 27215-8700
Phone (336) 538-7000
15327 McKays Lark
San Antonio, TX 78253-6507
Phone (907) 228-7660
1629 E Division St
River Falls, WI 54022-1571
Phone (715) 307-6000
180 Rowland Way
Novato, CA 94945-5009
Phone (844) 496-9160
1840 Amherst St
Winchester, VA 22601-2808
Phone (540) 536-8700
20103 Lake Chabot Rd
Castro Valley, CA 94546-5305
Phone (844) 496-9160
2500 Grant Rd
Mountain View, CA 94040-4302
Phone (844) 496-9160
2505 Mission Dr
Jefferson City, MO 65109-9508
Phone (573) 681-3249
2701 W Edgewood Dr
101 SSM Health Medical Group Behaviora
Jefferson City, MO 65109-5890
Phone (573) 634-5303
275 Hospital Dr
Ukiah, CA 95482-4531
Phone (844) 496-9160
30 Mark W Springs Rd
Santa Rosa, CA 95403-1436
Phone (844) 496-9160
300 Hospital Dr
Vallejo, CA 94589-2574
Phone (844) 496-9160
3100 Tongass Ave
Ketchikan, AK 99901-5746
Phone (907) 228-8300
317 Western Blvd
Jacksonville, NC 28546-6338
Phone (910) 577-2345
3300 Rivermont Ave
Lynchburg, VA 24503-2030
Phone (434) 200-5999
3318 N 14TH St
Bismarck, ND 58503-1614
Phone (701) 323-8300
3333 Riverbend Dr
Springfield, OR 97477-8800
Phone (541) 222-6000
350 7TH St N
Naples Community Hospital
Naples, FL 34102-5754
Phone (239) 436-5100
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 218873 | AK | MD | Psychiatry Physician |
| 91977 | GA | MD | Psychiatry Physician |
| 04-47333 | KS | MD | Psychiatry Physician |
| 73990 | MN | MD | Psychiatry Physician |
| MED-PHYS-LIC-118481 | MT | MD | Psychiatry Physician |
| 20166 | ND | MD | Psychiatry Physician |
| MD213412 | OR | MD | Psychiatry Physician |
| 65845 | TN | MD | Psychiatry Physician |
| CDR.0004311 | CO | MD | Child & Adolescent Psychiatry Physician |
Practice roles (60 of 104)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peacehealth | Current | Accepting new patients | |
| The Moses H. Cone Memorial Hospital Operating Corporation | Current | Accepting new patients | |
| Bozeman Health Deaconess Hospital | Current | Accepting new patients | |
| Winchester Medical Center | Current | Accepting new patients | |
| Shenandoah Memorial Hospital, Inc. | Current | Accepting new patients | |
| Nchmd, Inc | Current | Accepting new patients | |
| SSM Regional Health Services | Current | Accepting new patients | |
| Carilion Medical Center | Current | Accepting new patients | |
| Capital Health Multispecialty Group | Psychiatry | Current | Accepting new patients |
| Page Memorial Hospital, Inc. | Current | Accepting new patients | |
| Mary Imogene Bassett Hospital | Current | Accepting new patients | |
| Riverside Physician Services Inc | Current | Accepting new patients | |
| Peacehealth | Current | Accepting new patients | |
| Peacehealth | Current | Accepting new patients | |
| Warren Memorial Hospital, Inc. | Psychiatry | Current | Accepting new patients |
| Mary Imogene Bassett Hospital | Current | Accepting new patients | |
| Memorial Hospital Association | Current | Accepting new patients | |
| CMH Physician Services, LLC | Psychiatry | Current | Accepting new patients |
| Riverside Physician Services Inc | Current | Accepting new patients | |
| Tower Health Medical Group | Psychiatry | Current | Accepting new patients |
| Baycare Behavioral Health Associates LLC | Psychiatry | Current | Accepting new patients |
| Geisinger Clinic | Current | Accepting new patients | |
| Edward W Sparrow Hospital Association | Current | Accepting new patients | |
| Sentara Medical Group | Current | Accepting new patients | |
| Peacehealth | Current | Accepting new patients | |
| Carolinas Medical Center | Current | Accepting new patients | |
| Allina Health System | Current | Accepting new patients | |
| Alamance Regional Medical Center, Inc. | Current | Accepting new patients | |
| Page Memorial Hospital, Inc. | Current | Accepting new patients | |
| Memorial Hospital Association | Current | Accepting new patients | |
| Allina Health System | Current | Accepting new patients | |
| Peacehealth | Psychiatry | Current | Accepting new patients |
| Legacy Salmon Creek Hospital | Current | Accepting new patients | |
| Carolinas Medical Center | Psychiatry | Current | Accepting new patients |
| Catholic Health Initiatives Colorado | Current | Accepting new patients | |
| Mission Health Community Multispecialty Providers, LLC | Current | Accepting new patients | |
| Billings Clinic | Current | Accepting new patients | |
| CMH Physician Services, LLC | Current | Accepting new patients | |
| Mindcare Solutions of Texas PA | Psychiatry | Current | Accepting new patients |
| Peacehealth | Current | Accepting new patients | |
| Asana Integrated Medical Group PC | Psychiatry | Current | Accepting new patients |
| Hampshire Memorial Hospital, Inc. | Current | Accepting new patients | |
| Warren Memorial Hospital, Inc. | Current | Accepting new patients | |
| Nuvance Health Medical Practice PC | Psychiatry | Current | Accepting new patients |
| Bozeman Health Deaconess Hospital | Current | Accepting new patients | |
| Mindcare Solutions PC | Psychiatry | Current | Accepting new patients |
| Peacehealth Medical Group | Psychiatry | Current | Accepting new patients |
| Mission Health Community Multispecialty Providers, LLC | Current | Accepting new patients | |
| Warren Memorial Hospital, Inc. | Current | Accepting new patients | |
| Winchester Medical Center | Current | Accepting new patients | |
| War Memorial Hospital, Inc. | Current | Accepting new patients | |
| War Memorial Hospital, Inc. | Current | Accepting new patients | |
| Teton County Hospital District | Current | Accepting new patients | |
| Peacehealth | Current | Accepting new patients | |
| Peacehealth | Current | Accepting new patients | |
| Uva Community Health Medical Group, LLC | Psychiatry | Current | Accepting new patients |
| Mission Community Anesthesiology Specialists LLC | Current | Accepting new patients | |
| Peacehealth | Current | Accepting new patients | |
| Geisinger Clinic | Current | Accepting new patients | |
| Allina Health System | Current | Accepting new patients |
Locations (25 of 94)
3100 Tongass Ave
Ketchikan, AK 99901
Phone (907) 225-4104
2500 Grant Rd
Mountain View, CA 94040
Phone (650) 903-9500
5555 W Las Positas Blvd
Pleasanton, CA 94588
Phone (925) 416-3418
275 Hospital Dr
Ukiah, CA 95482
Phone (707) 462-7900
1000 Nut Tree Rd
Vacaville, CA 95687
Phone (707) 446-4000
9100 E Mineral Cir
Centennial, CO 80112
Phone (303) 561-5193
11600 W 2nd Pl
Lakewood, CO 80228
Phone (720) 321-1010
41 State Highway 67
Woodland Park, CO 80863
Phone (719) 686-0551
701 W Plymouth Ave
Deland, FL 32720
Phone (386) 943-3160
4211 Van Dyke Rd
Lutz, FL 33558
Phone (813) 265-6300
350 7th St N
Naples, FL 34102
Phone (239) 436-5000
680 2nd Ave N
Ste 304
Naples, FL 34102
Phone (239) 261-7711
6600 Madison St
New Pt Richey, FL 34652
Phone (727) 841-4611
425 W Colonial Dr
Ste 302
Orlando, FL 32804
Phone (330) 414-9233
7512 Dr Phillips Blvd
Ste 50
Orlando, FL 32819
Phone (786) 375-1500
1 Adventhealth Way
Palm Coast, FL 32137
Phone (330) 414-9233
3503 E Frontage Rd
Tampa, FL 33607
Phone (813) 586-8187
304 Turner McCall Blvd SW
Rome, GA 30165
Phone (706) 506-5000
306 Shorter Ave NW
Rome, GA 30165
Phone (706) 509-3500
420 E 2nd Ave
Ste 103
Rome, GA 30161
Phone (706) 509-3278
7655 Solutions Ctr
Chicago, IL 60677
8175 Reliable Pkwy
Chicago, IL 60686
1210 W Saginaw St
Fl 2
Lansing, MI 48915
Phone (517) 364-7575
1215 E Michigan Ave
Lansing, MI 48912
Phone (517) 336-8080
2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800
Interoperability endpoints
- kkodjo2994640@carolinashealthcaresystem.direct-ci.com
- kkodjo520308@direct.healthsystem.virginia.edu
- kkodjo628231@excellian.direct.allina.com
- kkodjo630069@direct.peacehealth.org
Organizations & group practices 106
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Acute Care Hospital
- Burlington, NC
- NPI 1326010273
-
- Psychiatry Physician
- Lutz, FL
- NPI 1245502152
-
dba Ctsa Cardiac Thor Surg
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Colorado Springs, CO
- NPI 1356783351
-
- Family Medicine Physician
- Lynchburg, VA
- NPI 1649228966
-
- Clinic/Center
- Portland, OR
- NPI 1902827272
-
- Hematology & Oncology Physician
- Naples, FL
- NPI 1831120195
-
- Internal Medicine Physician
- Poughkeepsie, NY
- NPI 1437358033
Psychiatry
-
dba Onslow Memorial Hospital
- General Acute Care Hospital
- Jacksonville, NC
- NPI 1679535496
Hospital & facility affiliations 11
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Lynchburg, VA
- NPI 1770693939
-
dba Centra Health Cardiothoracic Surgery
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Lynchburg, VA
- NPI 1407884448
Hospital
-
dba The Pain Center
- Pain Medicine (Anesthesiology) Physician
- Lynchburg, VA
- NPI 1811925852
Hospital
-
dba The Wound Care Center
- Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
- Lynchburg, VA
- NPI 1902834948
Hospital
-
dba CMG Vascular Surgery
- Vascular Surgery Physician
- Lynchburg, VA
- NPI 1144880782
Hospital
-
dba Centra Medical Group Stroobants Cardiovascular Center
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Lynchburg, VA
- NPI 1184964124
Hospital
-
dba Centra Lynchburg Hematology and Oncology
- Hematology & Oncology Physician
- Lynchburg, VA
- NPI 1700293628
Hospital
-
- General Acute Care Hospital
- Rhinebeck, NY
- NPI 1124072715
-
- General Acute Care Hospital
- Harrisonburg, VA
- NPI 1780694372
-
- General Acute Care Hospital
- Poughkeepsie, NY
- NPI 1740233899
-
dba Vassar Diagnostics
- Clinical Medical Laboratory
- Poughkeepsie, NY
- NPI 1780052514
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782691200000",
"number": "1780100958",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "915 HIGHLAND BLVD",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "597156902",
"telephone_number": "406-414-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "915 HIGHLAND BLVD",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "597156902",
"telephone_number": "406-414-5000"
}
],
"practiceLocations": [
{
"address_1": "4050 Coon Rapids Blvd NW",
"address_purpose": "LOCATION",
"city": "Coon Rapids",
"state": "MN",
"postal_code": "554332522",
"country_code": "US",
"telephone_number": "612-262-1220",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2000 Brookside Dr",
"address_purpose": "LOCATION",
"city": "Kingsport",
"state": "TN",
"postal_code": "376604627",
"country_code": "US",
"telephone_number": "423-857-7000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3333 Riverbend Dr",
"address_purpose": "LOCATION",
"city": "Springfield",
"state": "OR",
"postal_code": "974778800",
"country_code": "US",
"telephone_number": "541-222-2185",
"fax_number": "541-222-2195",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1515 Village Dr",
"address_purpose": "LOCATION",
"city": "Cottage Grove",
"state": "OR",
"postal_code": "974249700",
"country_code": "US",
"telephone_number": "458-205-6555",
"fax_number": "458-205-6570",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1990 Holton Ave E",
"address_purpose": "LOCATION",
"city": "Big Stone Gap",
"state": "VA",
"postal_code": "242193350",
"country_code": "US",
"telephone_number": "276-523-3111",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1 Medical Park Blvd",
"address_purpose": "LOCATION",
"city": "Bristol",
"state": "TN",
"postal_code": "376207430",
"country_code": "US",
"telephone_number": "423-844-1121",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "400 N State Of Franklin Rd",
"address_purpose": "LOCATION",
"city": "Johnson City",
"state": "TN",
"postal_code": "376046035",
"country_code": "US",
"telephone_number": "423-431-6111",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "851 Locust St",
"address_purpose": "LOCATION",
"city": "Rogersville",
"state": "TN",
"postal_code": "378572407",
"country_code": "US",
"telephone_number": "423-921-7000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "400 9th St",
"address_purpose": "LOCATION",
"city": "Florence",
"state": "OR",
"postal_code": "974397398",
"country_code": "US",
"telephone_number": "458-205-6555",
"fax_number": "458-205-6577",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1500 Commonwealth Ave",
"address_purpose": "LOCATION",
"city": "Williamsburg",
"state": "VA",
"postal_code": "231855229",
"country_code": "US",
"telephone_number": "757-585-2250",
"fax_number": "757-903-2285",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1020 First Colonial Rd Ste A",
"address_purpose": "LOCATION",
"city": "Virginia Beach",
"state": "VA",
"postal_code": "234543078",
"country_code": "US",
"telephone_number": "757-395-1850",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "11600 W 2nd Pl",
"address_purpose": "LOCATION",
"city": "Lakewood",
"state": "CO",
"postal_code": "802281527",
"country_code": "US",
"telephone_number": "720-321-0000",
"fax_number": "720-321-4165",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1501 W Elk Ave",
"address_purpose": "LOCATION",
"city": "Elizabethton",
"state": "TN",
"postal_code": "376432874",
"country_code": "US",
"telephone_number": "423-542-1300",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2030 Temple Hill Rd",
"address_purpose": "LOCATION",
"city": "Erwin",
"state": "TN",
"postal_code": "376508721",
"country_code": "US",
"telephone_number": "423-743-3141",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "130 W Ravine Rd",
"address_purpose": "LOCATION",
"city": "Kingsport",
"state": "TN",
"postal_code": "376603837",
"country_code": "US",
"telephone_number": "423-224-4000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3100 Tongass Ave",
"address_purpose": "LOCATION",
"city": "Ketchikan",
"state": "AK",
"postal_code": "999015746",
"country_code": "US",
"telephone_number": "907-228-7660",
"fax_number": "907-228-8140",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "16000 Johnston Memorial Dr",
"address_purpose": "LOCATION",
"city": "Abingdon",
"state": "VA",
"postal_code": "242117664",
"country_code": "US",
"telephone_number": "276-258-1000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2017 Jefferson St SW",
"address_purpose": "LOCATION",
"city": "Roanoke",
"state": "VA",
"postal_code": "240142419",
"country_code": "US",
"telephone_number": "540-981-8025",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "401 E Spruce St",
"address_purpose": "LOCATION",
"city": "Garden City",
"state": "KS",
"postal_code": "678465679",
"country_code": "US",
"telephone_number": "303-673-7531",
"fax_number": "303-397-2054",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1519 Main St",
"address_purpose": "LOCATION",
"city": "Sneedville",
"state": "TN",
"postal_code": "378693657",
"country_code": "US",
"telephone_number": "423-733-5000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1420 Tusculum Blvd",
"address_purpose": "LOCATION",
"city": "Greeneville",
"state": "TN",
"postal_code": "377454279",
"country_code": "US",
"telephone_number": "423-787-5000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1901 S Shady St",
"address_purpose": "LOCATION",
"city": "Mountain City",
"state": "TN",
"postal_code": "376832021",
"country_code": "US",
"telephone_number": "423-727-1100",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "245 Medical Park Dr",
"address_purpose": "LOCATION",
"city": "Marion",
"state": "VA",
"postal_code": "243541100",
"country_code": "US",
"telephone_number": "276-378-1000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "58 Carroll Street",
"address_purpose": "LOCATION",
"city": "Lebanon",
"state": "VA",
"postal_code": "242664510",
"country_code": "US",
"telephone_number": "276-883-8000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "312 Hospital Dr",
"address_purpose": "LOCATION",
"city": "Clintwood",
"state": "VA",
"postal_code": "242286786",
"country_code": "US",
"telephone_number": "276-926-0300",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "300 Med Tech Pkwy",
"address_purpose": "LOCATION",
"city": "Johnson City",
"state": "TN",
"postal_code": "376042277",
"country_code": "US",
"telephone_number": "423-302-1000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KODJO",
"first_name": "KODJOVI",
"middle_name": "DINYEFAN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-08-18",
"last_updated": "2026-06-29",
"certification_date": "2026-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "VA",
"license": "0101268565",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "GA",
"license": "91977",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MT",
"license": "MED-PHYS-LIC-118481",
"primary": true
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "OR",
"license": "MD213412",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CO",
"license": "CDR.0004311",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TN",
"license": "65845",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "ND",
"license": "20166",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "KS",
"license": "04-47333",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "AK",
"license": "218873",
"primary": false
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "CO",
"license": "CDR.0004311",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MN",
"license": "73990",
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kkodjo628231@excellian.direct.allina.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CDA/PDF/TXT",
"address_1": "4050 Coon Rapids Blvd NW",
"city": "Coon Rapids",
"state": "MN",
"country_code": "US",
"postal_code": "554332522",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Bozeman, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.