Healthcare Provider Details

I. General information

NPI: 1497615744
Provider Name (Legal Business Name): DR. TAESUN HAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 ALAMEDA AVE
EL PASO TX
79905-2705
US

IV. Provider business mailing address

5130 GATEWAY BLVD E
EL PASO TX
79905-1608
US

V. Phone/Fax

Practice location:
  • Phone: 915-215-6000
  • Fax: 915-545-6607
Mailing address:
  • Phone: 915-215-4480
  • Fax: 915-215-5386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number48705
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number48705
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: