Individual provider Active NPI

Ki-Yoon Kim, M.D.

  • Gastroenterology Physician
  • San Diego, CA
National Provider Identifier
1558715110
Registry record updated Oct 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
A151164 Issued in CA
Practice address
4060 Fourth Avenue, Suite 240
San Diego, CA 92103
Phone
(619) 291-6064
NPI assigned
Apr 20, 2016
Last updated
Oct 2, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 2, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 315245 NY
Gastroenterology Physician 207RG0100X A151164 CA Primary

Addresses

Primary practice location

4060 Fourth Avenue, Suite 240
San Diego, CA 92103

Mailing address

4060 Fourth Ave Ste 240
San Diego, CA 92103-2120
Phone (619) 291-6064

Other identifiers 1

IdentifierTypeStateIssuer
KK3232267556MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241115000391 CA Practitioner - Internal MedicinePractitioner - Gastroenterology 9234516626 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rutgers New Jersey Medical School, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
San Diego Gastroenterology Medical AssociatesGroup PAC ID 8123008935, 10 clinicians
On Call Specialists Medical Group of San Diego IncGroup PAC ID 7911395231, 145 clinicians

Practice addresses (Care Compare)

Tustin, CA 92780
Phone (714) 987-1121

1025 S Anaheim Blvd
Anaheim, CA 92805-5806
Phone (714) 987-1121

1111 W la Palma Ave
Anaheim, CA 92801-2804
Phone (714) 987-1121

1211 W la Palma Ave
Suite 404
Anaheim, CA 92801-2806
Phone (714) 772-8282

4060 4TH Ave
Suite 240
San Diego, CA 92103-2120
Phone (619) 291-6064

4077 5TH Ave
San Diego, CA 92103-2105
Phone (619) 359-6600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy113
Upper gastrointestinal (GI) endoscopy for acid reflux189

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A151164CAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kyk Medical Professional Corporation Gastroenterology CurrentSince Jun 22, 2025 Accepting new patients
Family Health Centers of San Diego Inc CurrentSince Dec 2, 2024 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Dec 2, 2024 Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Scripps Health Current Accepting new patients
Chest and Critical Care Consultants a Medical Group CurrentSince Oct 12, 2025 Accepting new patients
Chest and Critical Care Consultants CurrentSince Oct 12, 2025 Accepting new patients
On Call Specialists Medical Group of San Diego, Inc. CurrentSince Jan 1, 2025 Accepting new patients

Locations

1211 W La Palma Ave
Ste 404
Anaheim, CA 92801
Phone (714) 772-1030

1211 W La Palma Ave
Ste 709
Anaheim, CA 92801
Phone (714) 808-9292

4077 5th Ave
San Diego, CA 92103
Phone (619) 260-7245

4094 4th Ave
San Diego, CA 92103
Phone (619) 515-2545

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

13522 Newport Ave
Ste 102
Tustin, CA 92780
Phone (714) 573-8200

650 E Devon Ave
Ste 165
Itasca, IL 60143
Phone (630) 285-1040

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • BSC 65 PLUS INDIVIDUAL MAPD
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: kkim286578@scrippshlth.medalliesdirect.net

Organizations & group practices 9

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

Hospital & facility affiliations 5

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": "1461110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790899200000",
    "number": "1558715110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 FOURTH AVE STE 240",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032120",
            "telephone_number": "619-291-6064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 FOURTH AVENUE, SUITE 240",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92103",
            "telephone_number": "619-291-6064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "KI-YOON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-20",
        "last_updated": "2026-10-02",
        "certification_date": "2026-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "315245",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "A151164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "KK3232267556",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.