Healthcare Provider Details

I. General information

NPI: 1679499073
Provider Name (Legal Business Name): HONG JUN JO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 EUCLID AVE
CLEVELAND OH
44106-1712
US

IV. Provider business mailing address

246 PATRICK JOHN DR
WADSWORTH OH
44281-8248
US

V. Phone/Fax

Practice location:
  • Phone: 216-368-6459
  • Fax:
Mailing address:
  • Phone: 614-499-8507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN.495499
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: