NPIMap

Individual provider Active NPI

Joo Young Kim, PA-C

  • Physician Assistant
  • Stanford, CA
National Provider Identifier
1477096766
Registry record updated Oct 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
55582 Issued in CA
Practice address
300 Pasteur Dr
Stanford, CA 94305-2200
Phone
(650) 723-4000
NPI assigned
Nov 18, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 55582 CA
Physician Assistant 363A00000X 55582 CA Primary

Addresses

Primary practice location

300 Pasteur Dr
Stanford, CA 94305-2200

Mailing address

300 Pasteur Dr
Stanford, CA 94305-2200
Phone (650) 723-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180809005497 CA Practitioner - Physician Assistant 4284996919 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stanford Health CareGroup PAC ID 6709797491, 3,152 clinicians
Scripps Health Inpatient Providers Medical Group IncGroup PAC ID 9436314762, 209 clinicians

Practice addresses (Care Compare)

300 Pasteur Dr
Stanford, CA 94305-2200
Phone (650) 723-4000

435 H St
Chula Vista, CA 91910-4307
Phone (619) 691-7000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
55582CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Stanford Health Care CurrentSince Jul 1, 2018 Accepting new patients
Stanford Health Care CurrentSince Jul 1, 2018 Accepting new patients
Scripps Health Current Accepting new patients
Fairview Regional Medical Center Authority Past Accepting new patients
The Cleveland Clinic Foundation Past Accepting new patients
Scripps Health Past Accepting new patients
Lucile Salter Packard Children'S Hospital at Stanford Past Accepting new patients
South Pointe Hospital Past Accepting new patients
Stanford Hospital and Clinics Past Accepting new patients
Scripps Health Past Accepting new patients

Locations

435 H St
Chula Vista, CA 91910
Phone (619) 691-7000

10666 N Torrey Pines Rd
La Jolla, CA 92037
Phone (858) 554-2626

300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761696000000",
    "number": "1477096766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-723-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-723-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JOO YOUNG",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-18",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "55582",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "55582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stanford, CA

Sources for this page

Verify at the official NPI Registry.