Healthcare Provider Details

I. General information

NPI: 1245811090
Provider Name (Legal Business Name): KACI DANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KACI DEJARNETTE MD

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 JEFFERSON AVE
MEMPHIS TN
38103-2807
US

IV. Provider business mailing address

877 JEFFERSON AVE
MEMPHIS TN
38103-2807
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-5988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number77135
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: