This study examined the impact of density, diversity, design, distance to transit, and destination accessibility, five measures, known as the 5Ds, that characterize the built environment, on pedestrian–vehicle crashes in Seoul, Korea. Using spatial analysis based on 500-m grid cells, this study employed negative binomial regression models on the frequencies of three specific types of pedestrian–vehicle crashes: crashes causing death, major injury, and minor injury to pedestrians. Analysis shows that compact and mixed-use urban environments represented by 5D measures have mixed effects on pedestrian safety. Trade-off effects are found between a higher risk for all types of pedestrian crashes, and a lower risk for fatal pedestrian crashes in 5D urban environments. As a design variable, a higher number of intersections is more likely to increase some types of pedestrian crashes, including fatal crashes, a finding which warrants policy attention to promote pedestrian safety near intersection areas. This study also confirms an urgent need to secure the travel safety of pedestrians near public transit stations due to the higher risk of pedestrian crashes near such facilities. Various destinations, such as retail stores, traditional markets, and hospitals, are associated with pedestrian crashes. Pedestrian safety measures should be implemented to reduce the likelihood of pedestrian crashes near major destination facilities.