Provider Demographics
NPI:1053096040
Name:CHINO STONE & SURGERY CENTER
Entity type:Organization
Organization Name:CHINO STONE & SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-902-0009
Mailing Address - Street 1:12611 9TH STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3528
Mailing Address - Country:US
Mailing Address - Phone:909-480-4968
Mailing Address - Fax:909-206-0628
Practice Address - Street 1:12611 9TH STREET
Practice Address - Street 2:SUITE D
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3528
Practice Address - Country:US
Practice Address - Phone:909-902-0009
Practice Address - Fax:909-206-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical