Basic Information
| Provider Information | |||||||||
| NPI: | 1669582318 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIN | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | JOYCE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3022 WILLIAMS DRIVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035739800 | ||||||||
| FaxNumber: | 7035732959 | ||||||||
| Practice Location | |||||||||
| Address1: | 3833 N FAIRFAX DRIVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035258863 | ||||||||
| FaxNumber: | 7035258238 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 10/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101054098 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110153970 | 01 | RR MEDICARE | OTHER | 5811414 | 05 | VA | MEDICAID |