Healthcare Provider Details

I. General information

NPI: 1346189271
Provider Name (Legal Business Name): RUTVIN JAGDISH KYADA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MASSACHUSETTS AVE
BOSTON MA
02118-2605
US

IV. Provider business mailing address

815 ALBANY ST APT 406B
ROXBURY MA
02119-2566
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5951
  • Fax: 617-414-9251
Mailing address:
  • Phone: 347-424-7836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: