NPIMap

Individual provider Active NPI

Yo Sup Kim, MD

  • Diagnostic Radiology Physician
  • Sacramento, CA
National Provider Identifier
1760001572
Registry record updated Aug 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
A200645 Issued in CA
Practice address
1625 Stockton Blvd Ste 207
Sacramento, CA 95816-7092
Phone
(916) 887-7862
Fax
(916) 736-5533
NPI assigned
Apr 11, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X A200645 CA Primary

Addresses

Primary practice location

1625 Stockton Blvd Ste 207
Sacramento, CA 95816-7092

Mailing address

PO Box 255228
Sacramento, CA 95865-5228
Phone (800) 470-0071

Other practice location 1

1130 W Michigan St Ste 318
Indianapolis, IN 46202-5209
Phone (317) 274-8282

Other practice location 2

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
I20250514001533 CA Practitioner - Diagnostic Radiology 6103257506 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Loyola University of Chicago, Stritch School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stanford Health CareGroup PAC ID 6709797491, 3,152 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A200645CAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stanford Health Care Diagnostic Radiology Current Accepting new patients
Stanford Health Care Diagnostic Radiology CurrentSince Jun 30, 2025 Accepting new patients
Stanford Health Care CurrentSince Jun 30, 2025 Accepting new patients
LPCH Medical Group Div of Lucile CurrentSince Jun 30, 2025 Accepting new patients

Locations

725 Welch Rd
Palo Alto, CA 94304
Phone (650) 497-8979

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

Organizations & group practices 4

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": "1586563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787011200000",
    "number": "1760001572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 255228",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958655228",
            "telephone_number": "800-470-0071",
            "fax_number": "916-854-6769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 STOCKTON BLVD STE 207",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958167092",
            "telephone_number": "916-887-7862",
            "fax_number": "916-736-5533"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1130 W Michigan St Ste 318",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025209",
            "country_code": "US",
            "telephone_number": "317-274-8282",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Pasteur Dr",
            "address_purpose": "LOCATION",
            "city": "Stanford",
            "state": "CA",
            "postal_code": "943052200",
            "country_code": "US",
            "telephone_number": "650-723-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "YO SUP",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-11",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A200645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.