Individual
CHANGKUOTH BOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1299 FARNAM ST STE 300, OMAHA, NE 68102-1857
(314) 252-0093
(314) 252-0093
Mailing address
1299 FARNAM ST STE 300, OMAHA, NE 68102-1857
(314) 252-0093
(314) 252-0093
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
—
NE
Other
Enumeration date
03/18/2026
Last updated
03/18/2026
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