Individual provider Active NPI

Alexandrea Hyunjee Kim, MD

  • Otolaryngology Physician
  • Southlake, TX
National Provider Identifier
1851920185
Registry record updated Sep 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
W4867 Issued in TX
Practice address
415 E Southlake Blvd Ste 101
Southlake, TX 76092-6279
Phone
(817) 512-2459
NPI assigned
Apr 7, 2020
Last updated
Sep 28, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician 2082S0099X W4867 TX
Otolaryngology Physician 207Y00000X W4867 TX Primary
Facial Plastic Surgery Physician 207YS0123X W4867 TX

Addresses

Primary practice location

415 E Southlake Blvd Ste 101
Southlake, TX 76092-6279

Mailing address

539 W Commerce St # 4002
Dallas, TX 75208-1953

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20250718000356 GA Practitioner - OtolaryngologyPractitioner - Plastic and Reconstructive Surgery 5092139345 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12471GAMDSpecialist
W4867TXMDFacial Plastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emory Medical Care Foundation Inc CurrentSince Jul 8, 2025 Accepting new patients
Emory Medical Care Foundation Inc CurrentSince Jul 8, 2025 Accepting new patients
The Emory Clinic Inc CurrentSince Jul 8, 2025 Accepting new patients
Emory Health Care Past Accepting new patients

Locations

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

2201 Henderson Mill Rd NE
Ste 160
Atlanta, GA 30345
Phone (404) 251-2193

3200 Downwood Cir NW
Atlanta, GA 30327
Phone (404) 351-0051

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

Interoperability endpoints

  • Direct secure messaging: akim93737@direct.emory.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1586217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790553600000",
    "number": "1851920185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "539 W COMMERCE ST # 4002",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752081953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 E SOUTHLAKE BLVD STE 101",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926279",
            "telephone_number": "817-512-2459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ALEXANDREA",
        "middle_name": "HYUNJEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-07",
        "last_updated": "2026-09-28",
        "certification_date": "2026-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2082S0099X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": "TX",
            "license": "W4867",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TX",
            "license": "W4867",
            "primary": true
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "TX",
            "license": "W4867",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

Verify at the official NPI Registry.