Healthcare Provider Details

I. General information

NPI: 1831356757
Provider Name (Legal Business Name): JOCHEN THORSTEN SCHAEFER M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 WILSHIRE BLVD STE 103
SANTA MONICA CA
90403-5743
US

IV. Provider business mailing address

PO BOX 392915
PITTSBURGH PA
15251-9915
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-0011
  • Fax: 310-828-2001
Mailing address:
  • Phone: 877-697-2447
  • Fax: 855-697-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberS3581
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number20391
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number61860
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberA93697
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: