Provider Demographics
NPI:1710440078
Name:KOJDER, PRISCILLA LY (MD)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:LY
Last Name:KOJDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:FONG
Other - Last Name:LY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12700 PARK CENTRAL DR STE 1210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-1522
Mailing Address - Country:US
Mailing Address - Phone:214-987-3376
Mailing Address - Fax:469-532-0273
Practice Address - Street 1:6750 N MACARTHUR BLVD STE 260
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2489
Practice Address - Country:US
Practice Address - Phone:214-987-3376
Practice Address - Fax:469-532-0273
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU8758207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery