Provider Demographics
NPI:1922414994
Name:JATIN KYADA, MD, PC
Entity Type:Organization
Organization Name:JATIN KYADA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JATIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KYADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-364-2020
Mailing Address - Street 1:5 FRAME AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1520
Mailing Address - Country:US
Mailing Address - Phone:484-364-2020
Mailing Address - Fax:
Practice Address - Street 1:5 FRAME AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1520
Practice Address - Country:US
Practice Address - Phone:484-364-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419822207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty