Provider Demographics
NPI:1184013518
Name:BONES SPINE SURGERY INC
Entity Type:Organization
Organization Name:BONES SPINE SURGERY INC
Other - Org Name:BONES & SPINE SURGERY INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:KAIREN
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-906-1116
Mailing Address - Street 1:25915 BARTON RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3818
Mailing Address - Country:US
Mailing Address - Phone:909-906-1116
Mailing Address - Fax:909-906-1117
Practice Address - Street 1:25915 BARTON RD STE 203
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3818
Practice Address - Country:US
Practice Address - Phone:909-906-1116
Practice Address - Fax:909-906-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207XS0117X
CAA00062867261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699704023OtherNPI
1699704023OtherNPI