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General NPI Number Information
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NPI Number | 1336035872
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Entity Type | Organization
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Legal Business Name | IMMERSIV HEALTH OF TEXAS, PLLC
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 382 NE 191ST ST STE 93920
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City | MIAMI
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State | FL
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Zip | 33179-3899
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Country | US
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Telephone | 877-551-6650
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Fax | 855-694-4656
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Provider Business Mailing Address
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Address Line | 382 NE 191ST ST
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City | MIAMI
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State | FL
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Zip | 33179-3899
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Country | US
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Telephone |
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Fax | 855-694-4656
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Authorized Official
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Title or Position | CEO
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Name | SON HEE HAN
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Credential |
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Telephone | 512-869-9323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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