Provider Demographics
NPI:1669582318
Name:LIN, KENNETH JOYCE (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:JOYCE
Last Name:LIN
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 1:3022 WILLIAMS DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031
Mailing Address - Country:US
Mailing Address - Phone:703-573-9800
Mailing Address - Fax:703-573-2959
Practice Address - Street 1:3833 N FAIRFAX DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203
Practice Address - Country:US
Practice Address - Phone:703-525-8863
Practice Address - Fax:703-525-8238
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054098207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110153970OtherRR MEDICARE
VA5811414Medicaid
886563G45Medicare PIN
110153970OtherRR MEDICARE