Provider Demographics
NPI:1497767248
Name:LIN, KENNETH WENSEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WENSEN
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:PO BOX 417346
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-7346
Mailing Address - Country:US
Mailing Address - Phone:703-558-1456
Mailing Address - Fax:
Practice Address - Street 1:4910 MASSACHUSETTS AVE NW
Practice Address - Street 2:SUITE 115
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4300
Practice Address - Country:US
Practice Address - Phone:877-677-3627
Practice Address - Fax:202-237-0076
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD034806207Q00000X
MDD0061159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine