Provider Demographics
NPI:1689654360
Name:KIN, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:KIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 745462
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-5462
Mailing Address - Country:US
Mailing Address - Phone:540-786-2100
Mailing Address - Fax:540-786-0677
Practice Address - Street 1:1451 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8424
Practice Address - Country:US
Practice Address - Phone:540-785-7810
Practice Address - Fax:540-786-3099
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101237887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101237887OtherLICENSE
VA8133869OtherMAMSI
VA000593674OtherAETNA CAP
VA178521OtherANTHEM
VA3780363OtherAETNA HMO
VACA9037OtherMCR RAILROAD GROUP
VA7417660OtherAETNA NON HMO
VA010163323Medicaid
VACO2375OtherMEDICARE GROUP
VA010163323Medicaid
VAP00250089Medicare PIN
VA178521OtherANTHEM