Provider Demographics
NPI:1699811364
Name:DEAN, TUAN KISHFRAN IMRAN (MD)
Entity Type:Individual
Prefix:MR
First Name:TUAN
Middle Name:KISHFRAN IMRAN
Last Name:DEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 BREWSTER ST E
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:ND
Mailing Address - Zip Code:58341-1653
Mailing Address - Country:US
Mailing Address - Phone:701-324-4651
Mailing Address - Fax:701-324-4687
Practice Address - Street 1:317 BREWSTER ST E
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:ND
Practice Address - Zip Code:58341-1653
Practice Address - Country:US
Practice Address - Phone:701-324-5131
Practice Address - Fax:701-324-5126
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229816207Q00000X
FLME105136207Q00000X
ND13697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004889900Medicaid