Jai Eun Kim, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

30777 Issued in SC

Practice address

103 Sum Mor Dr
West Columbia, SC 29169-4828

Phone

(803) 254-4699

NPI assigned

Feb 17, 2025

Last updated

Oct 2, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of South Carolina School of Medicine, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Pivotal Injury and Rehab Inc

  dba Pivotal Health and Rehab

  • Multi-Specialty Clinic/Center
  • West Columbia, SC
  • NPI 1386150613
  Medicare reassignment NPD

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

{
    "created_epoch": "1739750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790899200000",
    "number": "1609671486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 FOREST DR STE 302",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292044057",
            "telephone_number": "803-699-8887",
            "fax_number": "803-699-8824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 SUM MOR DR",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291694828",
            "telephone_number": "803-254-4699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JAI",
        "middle_name": "EUN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-17",
        "last_updated": "2026-10-02",
        "certification_date": "2026-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "SC",
            "license": "30777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "16628832",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacey Khalifa, LISW-CP
• Sameena Anne Khan, M.D
• Leon J Khoury Jr., MD
• Connor Mackenzie Kiker, APRN
• Mark Duane Kilgus, MD
• James Kim, DO
• Betsy Lynn Kimbrell, RPH
• Carl O. Kinard, M.D.
• Philip Whitaker Kinder, M.D.
• Alyssa King, PHARMD

• Psychiatric/Mental Health Nurse Practitioner in West Columbia, SC
• Providers in West Columbia, SC by specialty
• Psychiatric/Mental Health Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.