Provider Demographics
NPI:1174307367
Name:LEE, GOSHENG
Entity type:Individual
Prefix:
First Name:GOSHENG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 204TH ST SW UNIT B
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6988
Mailing Address - Country:US
Mailing Address - Phone:559-540-6538
Mailing Address - Fax:
Practice Address - Street 1:2611 204TH ST SW UNIT B
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6988
Practice Address - Country:US
Practice Address - Phone:559-540-6538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician