Provider Demographics
NPI:1891948717
Name:ETC CONSULTANTS INC
Entity Type:Organization
Organization Name:ETC CONSULTANTS INC
Other - Org Name:LORPHEN MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES TUAN-TU
Authorized Official - Middle Name:SONG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-689-9754
Mailing Address - Street 1:6 COLOMA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2438
Mailing Address - Country:US
Mailing Address - Phone:949-689-9754
Mailing Address - Fax:949-313-5078
Practice Address - Street 1:3151 AIRWAY AVE STE T3
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4627
Practice Address - Country:US
Practice Address - Phone:949-689-9754
Practice Address - Fax:714-545-5748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA695422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA69542OtherSTATE LECENSE