Provider Demographics
NPI:1497767172
Name:MORI, JOHN KENNETH (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KENNETH
Last Name:MORI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 WOODMONT LN UNIT B
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-1714
Mailing Address - Country:US
Mailing Address - Phone:615-509-0584
Mailing Address - Fax:
Practice Address - Street 1:4895 RIVERBEND RD
Practice Address - Street 2:SUITE A
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2640
Practice Address - Country:US
Practice Address - Phone:720-279-9098
Practice Address - Fax:720-540-4250
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN424652084S0012X
CODR.0057674207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK167432OtherMEDICARE
KY7100048410Medicaid
TN3044034Medicare UPIN