Provider Demographics
NPI:1174533178
Name:KOKKO, KENNETH E (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:E
Last Name:KOKKO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 N LYERLY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2743
Mailing Address - Country:US
Mailing Address - Phone:423-702-7904
Mailing Address - Fax:423-826-8010
Practice Address - Street 1:979 E 3RD ST # B1010
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-778-8067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN55580207RN0300X
GA040709207RN0300X
MS20740207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0009063750Medicaid
MSP01233207OtherRAILROAD MEDICARE
AL202312Medicaid
TNQ027635Medicaid
TNQ027635Medicaid
TNQ027635Medicaid
MS02858713Medicaid
MS302I398902Medicare PIN