Chino Stone & Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

CHINO STONE & SURGERY CENTER

Practice address

12611 9TH Street
Suite D
Chino, CA 91710-3528

Phone

(909) 902-0009

Fax

(909) 206-0628

NPI assigned

Jun 19, 2023

Last updated

Mar 26, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. David G Song, M.D.NPI 1699115972

Title

Medical Director

Phone

(909) 902-0009

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053096040. Details of each certification follow.

• CCN 55C0001176 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 55C0001176

Legal name

CHINO STONE & SURGERY CENTER

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Sep 5, 2024

Last certification

Sep 5, 2024

Ownership / control type

Proprietary

Facility address

12611 9TH St. Suite D
Chino, CA 91710

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David Song

  • Urology Physician
  • Chino, CA
  • NPI 1699115972
  NPD Authorized official
• Gilan Angeles Magdangal, NP

  • Family Nurse Practitioner
  • Chino, CA
  • NPI 1538830765
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742947200000",
    "number": "1053096040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12611 9TH STREET",
            "address_2": "SUITE D",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917103528",
            "telephone_number": "909-480-4968",
            "fax_number": "909-206-0628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12611 9TH STREET",
            "address_2": "SUITE D",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917103528",
            "telephone_number": "909-902-0009",
            "fax_number": "909-206-0628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHINO STONE & SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-19",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A",
        "authorized_official_last_name": "SONG",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "909-902-0009",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chino Optometry Center
• Chino Pediatrics Medical Clinic, Inc.
• Chino Physical Therapy Inc.
• Chino Premier Surgery Center Limited Partnership
• Chino Spectrum Optometry PC
• Chino Unified School District
• Chino Valley Family Physicians a Medical Group
• Chino Valley Medical Center
• Chino Valley Medical Group
• Chino Valley Orthopedic Center Inc

• Ambulatory Surgical Clinic/Center in Chino, CA
• Providers in Chino, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.