MEDICARE: IMMERSIV HEALTH OF COLORADO, PLLC

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	207RI0200X	Infectious Disease Physician

General Provider Information

NPI Number	:	1649168238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMMERSIV HEALTH OF COLORADO, PLLC

Provider Business Mailing Address
First Line	:	382 NE 191ST ST STE 93920
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-3899
Country	:	US
Telephone Number	:	877-551-6650
Fax Number	:	855-694-4656

Provider Business Practice Location Address
First Line	:	7505 VILLAGE SQUARE DR STE 105
Second Line	:
City	:	CASTLE PINES
State	:	CO
Zip	:	80108-3692
Country	:	US
Telephone Number	:	877-551-6650
Fax Number	:	855-694-4656

Authorized Official
Title or Position	:	CEO
Name	:	SON HEE HAN
Credential	:
Telephone Number	:	512-869-9323

Provider Enumeration Date	:	06/24/2025
Last Update Date	:	06/25/2025

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