MEDICARE: GATEWAYS HOSPITAL AND MENTAL HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	283Q00000X	Psychiatric Hospital	930000058	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05-4028	OTHER	CA	MEDICARE (NOT SURE WHAT TYPE, IT JUST SAYS MEDICARE NUMBER)

General Provider Information

NPI Number	:	1740655661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAYS HOSPITAL AND MENTAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	1891 EFFIE STREET
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-1711
Country	:	US
Telephone Number	:	323-644-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 W COLLEGE ST STE 500
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-1246
Country	:	US
Telephone Number	:	323-644-2000
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	PHILIP WONG
Credential	:	PSY.D
Telephone Number	:	323-644-2000

Provider Enumeration Date	:	12/03/2015
Last Update Date	:	12/08/2025

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Directions to “GATEWAYS HOSPITAL AND MENTAL HEALTH CENTER ” Practice Location

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