Provider Demographics
NPI:1386636579
Name:CHUNG, SIMON SINMIN (MD)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:SINMIN
Last Name:CHUNG
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 1:8503 ARLINGTON BLVD
Mailing Address - Street 2:#310
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4628
Mailing Address - Country:US
Mailing Address - Phone:703-208-4200
Mailing Address - Fax:703-876-1799
Practice Address - Street 1:8081 INNOVATION PARK DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4867
Practice Address - Country:US
Practice Address - Phone:571-472-4724
Practice Address - Fax:571-472-0241
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044320208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010272891Medicaid
4312086OtherAETNA PPO
502647OtherNCPPO
1224156OtherAETNA HMO
540911708OtherMAMSI LIFE/ALLIANCE
188960OtherANTHEM PROSPERITY
192394OtherANTHEM FAIR OAKS
N1900014OtherCAREFIRST BCBS