Provider Demographics
NPI:1821013731
Name:HO, LYN WAN-KUO (MD)
Entity type:Individual
Prefix:DR
First Name:LYN
Middle Name:WAN-KUO
Last Name:HO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3015 WILLIAMS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4623
Mailing Address - Country:US
Mailing Address - Phone:703-641-9133
Mailing Address - Fax:
Practice Address - Street 1:4445 WILLARD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-3690
Practice Address - Country:US
Practice Address - Phone:301-907-7414
Practice Address - Fax:703-280-5098
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD607992085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409422100Medicaid
MDM60891OtherMARYLAND CDS #
MDM60891OtherMARYLAND CDS #
MD409422100Medicaid
MDI54026Medicare UPIN
MDH380O070Medicare PIN