Provider Demographics
NPI:1003924663
Name:BYNUM, JASON P (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:P
Last Name:BYNUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JASON
Other - Middle Name:P
Other - Last Name:BYNUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8001 BRUCEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2329
Mailing Address - Country:US
Mailing Address - Phone:916-897-7838
Mailing Address - Fax:888-812-0303
Practice Address - Street 1:8001 BRUCEVILLE RD
Practice Address - Street 2:KAISER PERMANENTE- SIERRA VISTA HOSPI
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2329
Practice Address - Country:US
Practice Address - Phone:916-897-7838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010830832084P0800X, 2084P0804X
CAA826962084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry