MEDICARE: DR. BROOKE BAFUS CHANDRASOMA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	A97268	CA
2	207R00000X	Internal Medicine Physician	A97268	CA
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	A97268	CA

General Provider Information

NPI Number	:	1770785610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BROOKE BAFUS CHANDRASOMA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 50027
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91115-0027
Country	:	US
Telephone Number	:	626-268-5691
Fax Number	:	626-268-5698

Provider Business Practice Location Address
First Line	:	950 S ARROYO PKWY STE 340
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3930
Country	:	US
Telephone Number	:	626-268-5691
Fax Number	:	626-268-5698

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	04/20/2026

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