Daftar Peserta BPJS Bangka Kabupaten

DAFTAR PESERTA PER ENTITAS
Nama Entitas : PEMERINTAH KABUPATEN BANGKA (01080098)

PEMERINTAH KABUPATEN BANGKA
Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Tingkat I
Nama Faskes Gigi
TMT
Status Peserta
Iuran Tgl. Registrasi
0001266564857 1901032912790003
WANTO
PESERTA
29/12/1979
BATURUSA
01/11/2015
AKTIF
19,225
19/10/2015
0001266566231 1901034908840002
sutina
ISTRI
09/08/1984
BATURUSA
01/11/2015
AKTIF
19,225
29/01/2014
0001266567467 1901032403080006
marvyn luckianto
ANAK
24/03/2008
BATURUSA
01/11/2015
AKTIF
19,225
29/01/2014
0001266568806 1901033108130002
kelvin arfando
ANAK
31/08/2013
BATURUSA
01/11/2015
AKTIF
19,225
29/01/2014
0001271160821 1901016404780002
HELMI ERNITA ARITONANG
PESERTA
15/02/1980
SUNGAILIAT
01/11/2015
AKTIF
19,225
16/10/2015
0001271161618 1901011708990004
RABINASWIL SAMUEL
NAPITUPULU
ANAK
17/08/1999
SUNGAILIAT
01/11/2015
AKTIF
19,225
12/02/2014
0001271162463 1901015202130001
HASMIRANDA GABERIA
NAPITUPULU
ANAK
12/02/2013
SUNGAILIAT
01/11/2015
AKTIF
19,225
12/02/2014
0001289941582 1901011511520001
SARIYAN
PESERTA
15/11/1952
SUNGAILIAT
01/03/2015
AKTIF
19,225
23/02/2015
0001289947083 1901012606400001
BUJANG ANWAR
PESERTA
26/06/1940
SUNGAILIAT
01/03/2015
AKTIF
19,225
23/02/2015
10
0001289948433 1901014606450010
MISNANI
ISTRI
06/06/1945
SUNGAILIAT
01/03/2015
AKTIF
19,225
01/04/2014
11
0001303521085 1901050705090002
RIDHO AKBAR SAFUTRA
PESERTA
07/05/2009
PEMALI
01/03/2015
AKTIF
19,225
24/02/2015
12
0001306173194 1901012304910004
MUHAMAD NURDIN
PESERTA
23/04/1991
SUNGAILIAT
01/04/2015
AKTIF
19,225
17/03/2015
13
0001306178021 1901016507900003
DOSY PUTRI MAYANDA
ISTRI
25/07/1990
SUNGAILIAT
01/04/2015
AKTIF
19,225
08/05/2014
14
0001306179775 1901016011070002
ARINDAH CAHAYA PUTRI
ANAK
20/11/2007
SUNGAILIAT
01/04/2015
AKTIF
19,225
08/05/2014
15
0001306174127 1901016502560001
HARNINGSIH
PESERTA
25/02/1956
SUNGAILIAT
01/04/2015
AKTIF
19,225
17/03/2015
16
0001308962474 1901050410010002
CRISTIAN ALDY
PESERTA
04/10/2001
PEMALI
01/05/2015
AKTIF
19,225
16/04/2015
17
0001317496937 1901016010540001
LIE MOI TUNG
PESERTA
20/10/1954
SINAR BARU
01/10/2015
AKTIF
19,225
15/09/2015
18
0001317633636 1901015002480003
PHOENG TJIT NIE
PESERTA
10/02/1948
SINAR BARU
01/09/2015
AKTIF
19,225
19/08/2015
19
0001320454811 1901020505520002
RIDUAN S
PESERTA
05/05/1952
BELINYU
01/10/2015
AKTIF
19,225
15/09/2015
12/2/15 3:15 PM
Page 1 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
20
0001320457735 1901027005560001
ZUWAIDAH
ISTRI
30/05/1956
BELINYU
01/10/2015
AKTIF
19,225
11/06/2014
21
0001322889129 1901020401720002
TAZWIR
PESERTA
04/01/1972
BELINYU
01/07/2015
AKTIF
19,225
16/06/2015
22
0001421919314 1901026301810000
SINTA
ISTRI
23/10/1981
BELINYU
01/07/2015
AKTIF
19,225
12/08/2014
23
0001322890402 1901081109050001
MUHAMMAD NASHATA
PRATAMA PUTRA
ANAK
11/09/2005
BELINYU
01/07/2015
AKTIF
19,225
17/06/2014
24
0001322906905 1901021002690001
TAWALANI
PESERTA
10/02/1969
BELINYU
01/07/2015
AKTIF
19,225
16/06/2015
25
0001322907827 1901027112730001
SUSILAWATI
ISTRI
31/12/1973
BELINYU
01/07/2015
AKTIF
19,225
17/06/2014
26
0001322916219 1901023009040002
RIZKI ARDIANSYAH
ANAK
30/09/2004
BELINYU
01/07/2015
AKTIF
19,225
17/06/2014
27
0001322916941 1901020107090002
IRWANSYAH
ANAK
01/07/2009
BELINYU
01/07/2015
AKTIF
19,225
17/06/2014
28
0001324939241 1901022502870002
FEBRIWARDANI
PESERTA
25/02/1987
BELINYU
01/07/2015
AKTIF
19,225
16/06/2015
29
0001324939318 1901065406850003
KASUMIATI
ISTRI
14/06/1985
BELINYU
01/07/2015
PENANGGUHAN PESERTA
19,225
21/06/2014
30
0001324939353 1901025305110001
MEIRINDA RESTU ADANTI
ANAK
13/05/2011
BELINYU
01/07/2015
PENANGGUHAN PESERTA
19,225
21/06/2014
31
0001328031988 1901014802460002
JUNIATI
PESERTA
08/02/1946
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/04/2015
32
0001328036297 1901012803570002
BUDI M. PASARIBU
PESERTA
28/03/1957
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/04/2015
33
0001328037535 1901015506590002
JUMIATI
ISTRI
15/06/1959
SUNGAILIAT
01/05/2015
AKTIF
19,225
30/06/2014
34
0001328039122 1901011401960004
RULI
ANAK
14/01/1996
SUNGAILIAT
01/05/2015
AKTIF
19,225
30/06/2014
35
0001339953671 1901020404640001
KARSODO
PESERTA
04/04/1964
BELINYU
01/12/2015
AKTIF
19,225
19/11/2015
36
0001340189054 1901026302670002
MARZANI
ISTRI
23/02/1967
BELINYU
01/12/2015
AKTIF
19,225
17/10/2014
37
0001340249793 1901021812940004
DEDI KUSUMA
ANAK
18/12/1994
BELINYU
01/12/2015
AKTIF
19,225
18/10/2014
38
0001340254438 1901020407020001
DEDI SAPUTRA
ANAK
04/07/2002
BELINYU
01/12/2015
AKTIF
19,225
18/10/2014
39
0001340254451 1901025807040001
SERLI ROSALINDA
ANAK
18/07/2004
BELINYU
01/12/2015
AKTIF
19,225
18/10/2014
40
0001453511891 1901020470020001
DERI SAPUTRA
ANAK
04/07/2002
BELINYU
01/12/2015
AKTIF
19,225
20/10/2014
41
0001381653189 1901011407400007
BURHANUDIN
PESERTA
14/07/1940
SUNGAILIAT
01/06/2015
AKTIF
19,225
15/05/2015
42
0001381655237 1901015903500001
AMINAH
ISTRI
19/03/1950
SUNGAILIAT
01/06/2015
AKTIF
19,225
08/07/2014
12/2/15 3:15 PM
Page 2 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
43
0001383020256 1901016501450001
ZAIDATI TALIB
PESERTA
25/01/1945
SUNGAILIAT
01/07/2015
PENANGGUHAN PESERTA
19,225
16/06/2015
44
0001383020313 1901012106700001
HERSUYADI
ANAK
21/06/1970
SUNGAILIAT
01/07/2015
AKTIF
19,225
12/07/2014
45
0001390294732 1901020107540021
EFENDI
PESERTA
01/07/1954
BELINYU
01/10/2015
PENANGGUHAN PESERTA
19,225
15/09/2015
46
0001420879511 1901021303090002
MUHAMMAD FAUZAN
PESERTA
13/03/2009
BELINYU
01/05/2015
AKTIF
19,225
16/04/2015
47
0001423220354 1901020812610001
AGUS PARDI
PESERTA
08/12/1961
BELINYU
01/10/2015
PENANGGUHAN PESERTA
19,225
15/09/2015
48
0001423220387 1901026408560001
HAPIANI
ISTRI
24/08/1956
BELINYU
01/10/2015
PENANGGUHAN PESERTA
19,225
14/08/2014
49
0001423797388 1901024606620001
MARYATI
PESERTA
06/06/1962
BELINYU
01/11/2015
AKTIF
19,225
19/10/2015
50
0001423797401 1901022801830001
maryanto
SUAMI
28/01/1983
BELINYU
01/11/2015
AKTIF
19,225
17/08/2014
51
0001423797434 1901021404920001
apriyanto
ANAK
14/04/1992
BELINYU
01/11/2015
AKTIF
19,225
17/08/2014
52
0001432425216 1901021608720001
AGUS SAPRIANTO
PESERTA
16/08/1972
BELINYU
01/10/2015
PENANGGUHAN PESERTA
19,225
15/09/2015
53
0001432425328 1901025706820001
HARIANA
ISTRI
17/06/1982
BELINYU
01/10/2015
AKTIF
19,225
04/09/2014
54
0001432425486 1901024706050001
IVANKA AGRELLA
ANAK
07/06/2005
BELINYU
01/10/2015
AKTIF
19,225
04/09/2014
55
0001433065544 1901022105690001
HERMAN
PESERTA
21/05/1969
BELINYU
01/10/2015
PENANGGUHAN PESERTA
19,225
15/09/2015
56
0001433065623 1901024104570003
MARYANI
ISTRI
01/04/1957
BELINYU
01/10/2015
AKTIF
19,225
06/09/2014
57
0001433667058 1901022612620001
MASRUR
PESERTA
26/12/1962
BELINYU
01/10/2015
PENANGGUHAN PESERTA
19,225
15/09/2015
58
0001433667699 1901024510710002
ratna
ISTRI
05/10/1971
BELINYU
01/10/2015
PENANGGUHAN PESERTA
19,225
08/09/2014
59
0001433668476 1901023107990002
muhammad hidayah
ANAK
31/07/1999
BELINYU
01/10/2015
PENANGGUHAN PESERTA
19,225
08/09/2014
60
0001435256381 1901026311520001
FAUZIAH
PESERTA
23/11/1952
BELINYU
01/10/2015
PENANGGUHAN PESERTA
19,225
15/09/2015
61
0001435256548 1901021103790001
NURMANSYAH
ANAK
11/03/1979
BELINYU
01/10/2015
PENANGGUHAN PESERTA
19,225
10/09/2014
62
0001436565418 1901021204820001
ARIANSYAH
PESERTA
12/04/1982
BELINYU
01/10/2015
PENANGGUHAN PESERTA
19,225
15/09/2015
63
0001436565475 1901024205820004
MEILIANTY
ISTRI
02/05/1982
BELINYU
01/10/2015
PENANGGUHAN PESERTA
19,225
13/09/2014
64
0001436565699 1901024709000002
bela anggelia
ANAK
07/09/2000
BELINYU
01/10/2015
PENANGGUHAN PESERTA
19,225
13/09/2014
65
0001436565789 1901024708110002
ZHAFIRA FITRIA
ANAK
07/08/2011
BELINYU
01/10/2015
PENANGGUHAN PESERTA
19,225
13/09/2014
12/2/15 3:15 PM
Page 3 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
66
0001438055414 1901010406500003
AMRAN ARIH
PESERTA
04/06/1950
SINAR BARU
01/09/2015
AKTIF
19,225
19/08/2015
67
0001438057899 1901016101550003
ASNAH
ISTRI
21/01/1955
SINAR BARU
01/09/2015
AKTIF
19,225
16/09/2014
68
0001438098153 1901020404840001
MIN FO
PESERTA
04/04/1984
BELINYU
01/07/2015
PENANGGUHAN PESERTA
19,225
16/06/2015
69
0001438102181
vinaka tuwensti pradini
ISTRI
04/03/1995
BELINYU
01/07/2015
AKTIF
19,225
16/09/2014
70
0001438104587 1901022403120002
rama danis wara
ANAK
24/03/2012
BELINYU
01/07/2015
AKTIF
19,225
16/09/2014
71
0001438188276 1901020904870001
AKHIAN
PESERTA
09/04/1987
BELINYU
01/07/2015
AKTIF
19,225
16/06/2015
72
0001438188456 1901025506930001
SUCI NIPRIANTI
ISTRI
15/06/1993
BELINYU
01/07/2015
AKTIF
19,225
16/09/2014
73
0001438188592 1901022507070001
RIDHO JULINSYAH
ANAK
17/05/2010
BELINYU
01/07/2015
AKTIF
19,225
16/09/2014
74
0001438623358 1901025705120002
RAISHA KLARA SABRINA
ANAK
17/05/2012
BELINYU
01/07/2015
AKTIF
19,225
17/09/2014
75
0001438203172 1901022404750001
EFFENDI
PESERTA
24/04/1975
BELINYU
01/10/2015
PENANGGUHAN PESERTA
19,225
15/09/2015
76
0001438203194 1901025010750001
ZARMIAH
ISTRI
10/10/1975
BELINYU
01/10/2015
AKTIF
19,225
16/09/2014
77
0001438203295 1901025407980002
INDRI JULIANTI
ANAK
14/07/1998
BELINYU
01/10/2015
AKTIF
19,225
16/09/2014
78
0001438203341 1901026308020001
ELSA FARIZAH
ANAK
23/08/2002
BELINYU
01/10/2015
AKTIF
19,225
16/09/2014
79
0001438203363 1901026504110001
INDIRA AFRILIANDA
ANAK
25/04/2011
BELINYU
01/10/2015
AKTIF
19,225
16/09/2014
80
0001438372506 1902010909720007
ARYAMIE
PESERTA
09/09/1972
TANJUNG PANDAN
01/06/2015
AKTIF
19,225
21/05/2015
81
0001438480157 1901022103760002
ABDUL HAMID
PESERTA
21/03/1976
BELINYU
01/12/2015
AKTIF
19,225
19/11/2015
82
0001438481136 1901025704810001
YUNI ARYU
ISTRI
17/04/1981
dr. MUJI ATMOJO
01/12/2015
AKTIF
19,225
17/09/2014
83
0001438482183
FIKRI
ANAK
19/05/2007
BELINYU
01/12/2015
AKTIF
19,225
17/09/2014
84
0001438483307 1901025705070001
DIVA STEFANI
ANAK
17/05/2007
BELINYU
01/12/2015
AKTIF
19,225
17/09/2014
85
0001439089064 1901021408760001
AGUSRIA
PESERTA
14/08/1976
BELINYU
01/07/2015
AKTIF
19,225
16/06/2015
86
0001439089683 1901026801840002
RUHAIMININGSIH
ISTRI
28/01/1984
BELINYU
01/07/2015
AKTIF
19,225
18/09/2014
87
0001439089997 1901024102060005
SAUSAN SYABIRAH
ANAK
01/02/2006
BELINYU
01/07/2015
AKTIF
19,225
18/09/2014
88
0001439091191 1901020101110001
MUHAMMAD RAHLIL AKBAR
ANAK
01/01/2011
BELINYU
01/07/2015
AKTIF
19,225
18/09/2014
12/2/15 3:15 PM
Page 4 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
89
0001439091404 1901026008130001
ALIKA SYIBILLA
ANAK
20/08/2013
BELINYU
01/07/2015
AKTIF
19,225
18/09/2014
90
0001439722989 1901011303790010
ROBERTO RAHMAT
PESERTA
13/03/1979
SUNGAILIAT
01/06/2015
AKTIF
19,225
12/05/2015
91
0001440615172 1901022711380001
BACHTIAR TAHER
PESERTA
27/11/1938
BELINYU
01/07/2015
AKTIF
19,225
16/06/2015
92
0001440615576 1901027112400002
HASMAWATI
ISTRI
31/12/1940
BELINYU
01/07/2015
AKTIF
19,225
22/09/2014
93
0001443476687 1901020207790001
PADLI
PESERTA
07/02/1979
BELINYU
01/12/2015
AKTIF
19,225
19/11/2015
94
0001443476733 1901026006840002
FITRIANI
ISTRI
20/06/1984
BELINYU
01/12/2015
AKTIF
19,225
28/09/2014
95
0001443476812 1901020709010004
MISDIN
ANAK
07/09/2001
BELINYU
01/12/2015
AKTIF
19,225
28/09/2014
96
0001443476867 1901020101070002
M. AJI AL FATONAH
ANAK
01/01/2007
BELINYU
01/12/2015
AKTIF
19,225
28/09/2014
97
0001443478386 1901022306730010
SUHERMAN
PESERTA
23/06/1973
BELINYU
01/10/2015
AKTIF
19,225
15/09/2015
98
0001443478419 1901016307810006
MULJATI
ISTRI
23/07/1981
BELINYU
01/10/2015
AKTIF
19,225
28/09/2014
99
0001443478454 1901026101020010
VIRGINIA SUHERMAN
ANAK
21/01/2003
BELINYU
01/10/2015
AKTIF
19,225
28/09/2014
100
0001443478498 1901015010080001
FLORENCIA SUHERMAN
ANAK
10/10/2008
BELINYU
01/10/2015
PENANGGUHAN PESERTA
19,225
28/09/2014
101
0001445187565 1901011307730003
ROMI KURNIAWAN
PESERTA
13/07/1973
SUNGAILIAT
01/03/2015
AKTIF
19,225
18/02/2015
102
0001445188263 1901016912780004
DESI SUSANTI
ISTRI
29/12/1978
SUNGAILIAT
01/03/2015
AKTIF
19,225
01/10/2014
103
0001445188533 1901012111000001
MUHAMMAD RIZKI PRATAMA
ANAK
21/11/2000
SUNGAILIAT
01/03/2015
AKTIF
19,225
01/10/2014
104
0001445189321 1901015505110001
CHIRA MAYLIQA
ANAK
15/05/2011
SUNGAILIAT
01/03/2015
AKTIF
19,225
01/10/2014
105
0001445191323 1901016808750004
WIDHI HASTUTI
PESERTA
28/08/1975
SUNGAILIAT
01/03/2015
AKTIF
19,225
18/02/2015
106
0001445192875 1901016205630002
HERLINA
PESERTA
22/05/1963
SUNGAILIAT
01/03/2015
AKTIF
19,225
18/02/2015
107
0001445201436 1901011112020003
REZY SAVSANA
ANAK
11/12/2002
SUNGAILIAT
01/03/2015
AKTIF
19,225
01/10/2014
108
0001446079228 1901014210870001
SRI HARTATI
PESERTA
02/10/1987
KENANGA
01/12/2015
AKTIF
19,225
19/11/2015
109
0001446081118 1901010512790002
CHANDRA GUNAWAN
SUAMI
05/12/1979
KENANGA
01/12/2015
AKTIF
19,225
03/10/2014
110
0001446081309 1901016603050001
VENICA LAVIN
ANAK
26/03/2005
KENANGA
01/12/2015
AKTIF
19,225
03/10/2014
111
0001446081502 1901016211120003
EVIN FEI RICARLA
ANAK
22/11/2012
KENANGA
01/12/2015
AKTIF
19,225
03/10/2014
12/2/15 3:15 PM
drg. DEWI SEPTARIA (JST)
Page 5 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
112
0001448425877 1901020202390002
SYAMSURI
PESERTA
02/02/1939
BELINYU
01/10/2015
AKTIF
19,225
15/09/2015
113
0001453556597 1901010608600002
ACHMAD
PESERTA
06/08/1960
SINAR BARU
01/12/2015
AKTIF
19,225
19/11/2015
114
0001453806696 1901016005670004
ROSMIYATI
ISTRI
20/05/1967
SINAR BARU
01/12/2015
AKTIF
19,225
23/10/2014
115
0001453806573 1901010211980003
ALFINDO
ANAK
02/11/1998
SINAR BARU
01/12/2015
AKTIF
19,225
23/10/2014
116
0001455131575 1901012306500001
USMADI
PESERTA
23/06/1950
SINAR BARU
01/09/2015
AKTIF
19,225
20/08/2015
117
0001455131711 1901015007540003
ROMIDAH
ISTRI
10/07/1954
SINAR BARU
01/09/2015
PENANGGUHAN PESERTA
19,225
07/11/2014
118
0001455131981 1901012308890003
JUMLI
ANAK
23/08/1989
SINAR BARU
01/09/2015
AKTIF
19,225
07/11/2014
119
0001455145874 1901015606630001
NONIDAH
PESERTA
16/06/1963
SUNGAILIAT
01/07/2015
AKTIF
19,225
16/06/2015
120
0001436616742 1901011212520001
AMAN ALIDIN
SUAMI
12/12/1952
SUNGAILIAT
01/07/2015
AKTIF
19,225
13/09/2014
121
0001455146166 1901015812910001
SELVI DIANA
ANAK
16/12/1997
SUNGAILIAT
01/07/2015
AKTIF
19,225
07/11/2014
122
0001457555973 1901010108680002
GUSTONI
PESERTA
01/08/1968
SUNGAILIAT
01/03/2015
AKTIF
19,225
23/02/2015
123
0001457556028 1901014111750002
SUAILI
ISTRI
01/11/1975
SUNGAILIAT
01/03/2015
AKTIF
19,225
29/11/2014
124
0001457556063 1901012805940001
MINDRI MULYANDA
ANAK
28/05/1994
SUNGAILIAT
01/03/2015
AKTIF
19,225
29/11/2014
125
0001457556096 1901016404040003
ALZIRA SIPAULAYA
ANAK
24/04/2004
SUNGAILIAT
01/03/2015
AKTIF
19,225
29/11/2014
126
0001459357481 1901020809610001
JASRI ACHMAD
PESERTA
08/09/1961
GUNUNG MUDA
01/10/2015
AKTIF
19,225
15/09/2015
127
0001459357751 1901027001660001
MARHIDAH
ISTRI
30/01/1966
GUNUNG MUDA
01/10/2015
AKTIF
19,225
09/12/2014
128
0001459358155 1901022105870001
DEFRIYANTO ARFIANSYAH
ANAK
21/05/1988
GUNUNG MUDA
01/10/2015
AKTIF
19,225
09/12/2014
129
0001459358717 1901020806060001
RAHMAT TOPIK HAMZAH
ANAK
08/06/2005
GUNUNG MUDA
01/10/2015
AKTIF
19,225
09/12/2014
130
0001459367864 1901010409560002
MAT SAHIN
PESERTA
04/09/1956
SINAR BARU
01/09/2015
AKTIF
19,225
20/08/2015
131
0001459367998 1901016212610001
NORMAH
ISTRI
22/12/1961
SINAR BARU
01/09/2015
AKTIF
19,225
09/12/2014
132
0001459965058 1901014304940001
RIKA
PESERTA
03/04/1994
SINAR BARU
01/10/2015
PENANGGUHAN PESERTA
19,225
15/09/2015
133
0001459965306 1901011308130004
RAFKA AL FIRNANDA
ANAK
13/08/2013
SINAR BARU
01/10/2015
AKTIF
19,225
11/12/2014
134
0001460265939 1901056307760002
YENNI
PESERTA
23/07/1976
KLINIK AL HUSNI
01/12/2015
AKTIF
19,225
19/11/2015
12/2/15 3:15 PM
Page 6 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
135
0001460265952 1901051710990003
REINALDY JOVANCA
ANAK
17/10/1999
KLINIK AL HUSNI
01/12/2015
AKTIF
19,225
13/12/2014
136
0001460265985 1901056502070003
KEIREN MERVINKAN
ANAK
25/02/2007
KLINIK AL HUSNI
01/12/2015
AKTIF
19,225
13/12/2014
137
0001460946295 1901010106600005
HASAN SETIADI
PESERTA
01/06/1960
SINAR BARU
01/10/2015
AKTIF
19,225
15/09/2015
138
0001460947228 1901014101670003
HALI MATU SAKDIAH
ISTRI
01/01/1967
SINAR BARU
01/10/2015
AKTIF
19,225
16/12/2014
139
0001460947263 1901011001020002
HARISWAN
ANAK
10/01/2002
SINAR BARU
01/10/2015
AKTIF
19,225
16/12/2014
140
0001462549094 1901025109420001
DJARIAH
PESERTA
11/09/1942
BELINYU
01/10/2015
AKTIF
19,225
15/09/2015
141
0001463133868 1901013001590001
M. ISA ZULPAKAR
PESERTA
30/01/1959
SINAR BARU
01/11/2015
AKTIF
19,225
19/10/2015
142
0001463133993 1901017012620004
MARIYANI
ISTRI
30/12/1962
SINAR BARU
01/11/2015
AKTIF
19,225
30/12/2014
143
0001463292112 1901011803750001
FATONI
PESERTA
18/03/1975
SINAR BARU
01/10/2015
AKTIF
19,225
15/09/2015
144
0001463292134 1901014412820002
ROFI'AH
ISTRI
04/12/1982
SINAR BARU
01/10/2015
PENANGGUHAN PESERTA
19,225
01/01/2015
145
0001463292145 1901015702040003
RIVANA ZELVI
ANAK
17/02/2004
SINAR BARU
01/10/2015
PENANGGUHAN PESERTA
19,225
01/01/2015
146
0001463292156 1901011005110002
BIJANA OVI PRTAMA
ANAK
10/05/2011
SINAR BARU
01/10/2015
AKTIF
19,225
01/01/2015
147
0001463515391 1901026301830001
SUDIRMAN
PESERTA
03/01/1983
BELINYU
01/12/2015
AKTIF
19,225
19/11/2015
148
0001463515402 1901020907850001
SYAHRIA
ISTRI
09/07/1985
BELINYU
01/12/2015
AKTIF
19,225
03/01/2015
149
0001463515424 1901023005090001
SALSABILA
ANAK
30/05/2009
BELINYU
01/12/2015
AKTIF
19,225
03/01/2015
150
0001464309235 1901011005640004
UMARENG
PESERTA
10/05/1964
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/04/2015
151
0001464309257 1901015404710009
RABIATUL ASDAWIYAH
ISTRI
14/04/1971
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/01/2015
152
0001464309279 1901011007870002
MARDIANTO
ANAK
10/07/1987
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/01/2015
153
0001464309303 1901011401890003
MURDIANSYAH
ANAK
14/01/1989
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/01/2015
154
0001464309336 1901014109950003
WINDA SAPUTRI
ANAK
01/09/1995
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/01/2015
155
0001464309347 1901012710980002
DENI SAPUTRA
ANAK
27/10/1998
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/01/2015
156
0001464309358 1901014912020001
DEVI YANTI
ANAK
09/12/2002
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/01/2015
157
0001464309369 1901010608040001
RISKI AGUSTIAN
ANAK
06/08/2004
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/01/2015
12/2/15 3:15 PM
Page 7 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
158
0001464309371 1901011304060003
RICO AFRIAN
ANAK
13/04/2006
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/01/2015
159
0001464309382 1901014107680014
HJ.SAMIA
TAMBAHAN
01/07/1968
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/01/2015
160
0001466768182 1610111608750003
IRSAN
PESERTA
16/08/1975
KENANGA
01/09/2015
AKTIF
19,225
21/08/2015
161
0001466768193 1610115407750001
EVI YULITA
ISTRI
14/07/1975
KENANGA
01/09/2015
AKTIF
19,225
20/02/2015
162
0001466768204 1610110107000092
AGUNG HIDAYATULLAH
ANAK
10/05/1999
KENANGA
01/09/2015
AKTIF
19,225
20/02/2015
163
0001466768215 1610110512060001
DERA HIDAYATULLAH
ANAK
05/12/2006
KENANGA
01/09/2015
AKTIF
19,225
20/02/2015
164
0001466768226 1610114512060001
DERI HIDAYATULLAH
ANAK
05/12/2006
KENANGA
01/09/2015
AKTIF
19,225
20/02/2015
165
0001468427128 1901025909570001
RUMIATI
PESERTA
19/09/1957
BELINYU
01/10/2015
AKTIF
19,225
15/09/2015
166
0001468427139 1901022610940001
ROLLY
ANAK
26/10/1994
BELINYU
01/10/2015
AKTIF
19,225
18/03/2015
167
0001468579419 1901015304490001
SAKDAH
PESERTA
13/04/1949
SINAR BARU
01/09/2015
AKTIF
19,225
20/08/2015
168
0001468579421 1901010503400001
MARSIDI MALIK
TAMBAHAN
05/03/1940
SINAR BARU
01/09/2015
AKTIF
19,225
19/03/2015
169
0001469996605 1905011501650001
HELMI
PESERTA
15/01/1965
BELINYU
01/10/2015
AKTIF
19,225
15/09/2015
170
0001469996616 1905016002670001
SUTIA
ISTRI
20/02/1967
BELINYU
01/10/2015
AKTIF
19,225
18/04/2015
171
0001469996627 1905011004070003
PUTRA
ANAK
10/04/2007
BELINYU
01/10/2015
AKTIF
19,225
18/04/2015
172
0001477266906 1901020107480007
ABDULLAH
PESERTA
01/07/1948
BELINYU
01/10/2015
AKTIF
19,225
15/09/2015
173
0001477266928 1901025805520001
MAROAINI
ISTRI
18/05/1952
BELINYU
01/10/2015
AKTIF
19,225
24/10/2014
174
0001478215923 1901014107620004
HAZIZA
PESERTA
01/07/1962
SINAR BARU
01/09/2015
AKTIF
19,225
20/08/2015
175
0001478216439 1901011610900003
DARWIN
ANAK
16/10/1990
SINAR BARU
01/09/2015
AKTIF
19,225
28/10/2014
176
0001478219207 1901010702710002
SURDIANTO
PESERTA
07/02/1971
SINAR BARU
01/10/2015
AKTIF
19,225
15/09/2015
177
0001478219589 1901015608710001
SASIDAH
ISTRI
16/08/1971
SINAR BARU
01/10/2015
AKTIF
19,225
28/10/2014
178
0001478220096 1901014112960002
SELVILIA MONA GITA
ANAK
01/12/1996
SINAR BARU
01/10/2015
AKTIF
19,225
28/10/2014
179
0001478220412 1901015911020001
SELLY LIA SANG DWI SRI ASIH ANAK
19/11/2002
SINAR BARU
01/10/2015
AKTIF
19,225
28/10/2014
180
0001478842312 1901015002690004
RUSMIATI
10/02/1967
SUNGAILIAT
01/11/2015
AKTIF
19,225
19/10/2015
12/2/15 3:15 PM
PESERTA
Page 8 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
181
0001480770347 1901014308520001
HASANAH
PESERTA
03/08/1952
SUNGAILIAT
01/10/2015
AKTIF
19,225
15/09/2015
182
0001480771236 1901014912680003
HARDANILA
TAMBAHAN
09/12/1968
SUNGAILIAT
01/10/2015
AKTIF
19,225
03/11/2014
183
0001483316886 1901011810350001
DJIE KIM LIM
PESERTA
18/10/1935
KENANGA
01/04/2015
AKTIF
19,225
17/03/2015
184
0001484734419 1901016001450002
SIM A KIAM
ISTRI
20/01/1942
KENANGA
01/04/2015
AKTIF
19,225
12/11/2014
185
0001505867409 1901011308720001
Rusman
PESERTA
13/08/1972
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
186
0001505868456 1901014409740001
Laba
ISTRI
09/04/1974
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
187
0001505869569 1901012610990001
Muhammad Ruslan
ANAK
26/10/1999
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
188
0001505870166 1901011103030001
Rusli
ANAK
03/11/2003
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
189
0001505870278 1901016503100001
Diah Permatasari
ANAK
25/03/2010
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
190
0001505867411 1901010201430002
104
Ambo Sakka
PESERTA
02/01/1943
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
191
0001505867422 1901015005400002
104
Suharmani
ISTRI
10/05/1940
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
192
0001505867433 1901014109430001
106
Wa Ube
PESERTA
01/09/1943
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
193
0001505867444 1901015010490002
107
Rosmala
PESERTA
10/10/1949
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
194
0001505867455 1901010912620002
108
Marzuki
PESERTA
09/12/1962
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
195
0001505867466 1901014804720002
108
Maryani
ISTRI
08/04/1972
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
196
0001505867477 1901010407940005
108
Hilman Syahril
ANAK
04/07/1994
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
197
0001505867488 1901014604030002
108
Hilda Apriyanti
ANAK
06/04/2003
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
198
0001505867499 1901012812550001
112
Hasanusi
PESERTA
28/12/1955
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
199
0001505867501 1901010204990002
112
Edo Sambara
ANAK
02/04/1999
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
200
0001505867512 1901077107600002
114
Mimi
PESERTA
31/07/1960
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
201
0001505867523 1901071902980001
114
Abdul Rahmat
ANAK
19/02/1998
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
202
0001505867534 1901015110320001
116
Jati Yasin
PESERTA
11/10/1932
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
203
0001505867545 1901012209650003
117
Suherman
PESERTA
22/09/1965
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
12/2/15 3:15 PM
Page 9 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
204
0001505867556 1901014708670004
117
Mariyani
ISTRI
07/08/1967
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
205
0001505867567 1901011807910004
117
Julianto
ANAK
18/07/1991
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
206
0001505867589 1901015611950004
117
Nora Heryani
ANAK
18/11/1995
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
207
0001505867578 1901050811690001
12
DIDIK HARI SAMBODO
PESERTA
08/11/1969
PEMALI
01/07/2015
AKTIF
19,225
23/06/2015
208
0001505867681 1901054509740001
12
SUPARTI
ISTRI
16/12/1974
PEMALI
01/07/2015
AKTIF
19,225
23/06/2015
209
0001505867591 1901010208820004
121
Sui Min
PESERTA
02/08/1982
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
210
0001505867602 1901011004840002
121
Sui Long
ANAK
10/04/1984
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
211
0001505867613 1901010906860004
121
Sui Phing
ANAK
09/06/1986
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
212
0001505867624 1901012208890004
121
Sui Ngian
ANAK
22/08/1989
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
213
0001505867635 1901016105590006
125
Zainab
PESERTA
21/05/1959
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
214
0001505867646 1901011911820005
125
Rahmat
ANAK
19/11/1982
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
215
0001505867657 1901016607880003
127
Zum Ratul Aini
PESERTA
25/07/1986
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
216
0001505867668 1901016603070001
127
Anggun
ANAK
16/03/2007
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
217
0001505867679 1901060702860001
129
ZAINUDIN
PESERTA
07/02/1986
BAKAM
01/07/2015
AKTIF
19,225
23/06/2015
218
0001505867692 1901064706930001
129
HOPSAH
ISTRI
08/03/1993
BAKAM
01/07/2015
AKTIF
19,225
23/06/2015
219
0001505867703 1901061610110001
131
RIFIKI AZZAM GHIFARI
PESERTA
16/10/2011
BAKAM
01/07/2015
AKTIF
19,225
23/06/2015
220
0001505867714 1901061108750001
132
ROMLI
PESERTA
11/08/1977
BAKAM
01/07/2015
AKTIF
19,225
23/06/2015
221
0001505867725 1901065412820001
132
SRIWANI
ISTRI
14/12/1981
BAKAM
01/07/2015
AKTIF
19,225
23/06/2015
222
0001505867736 1901064301010001
132
ZILNA TAVERA PURNAWATI
ANAK
22/07/2002
BAKAM
01/07/2015
AKTIF
19,225
23/06/2015
223
0001505867747 1901062003081726
132
ATTALARIKH ZAMARSYAH
ANAK
20/03/2008
BAKAM
01/07/2015
AKTIF
19,225
23/06/2015
224
0001505867758 1901061504600001
136
BASRI
PESERTA
15/04/1960
BAKAM
01/07/2015
AKTIF
19,225
23/06/2015
225
0001505867769 1901062810920002
136
RUMLAH
ISTRI
01/07/1961
BAKAM
01/07/2015
AKTIF
19,225
23/06/2015
226
0001505867771 1901011608720002
138
Hadi Pernomo
PESERTA
16/08/1972
KENANGA
01/07/2015
AKTIF
19,225
23/06/2015
12/2/15 3:15 PM
Page 10 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
227
0001505867782 1901014906790006
138
Tuti Hartati
ISTRI
06/09/1979
KENANGA
01/07/2015
AKTIF
19,225
23/06/2015
228
0001505867804 1901012908040002
138
M. Adit Putra Mahardika
ANAK
29/06/2004
KENANGA
01/07/2015
AKTIF
19,225
23/06/2015
229
0001505867815 1901014304100002
138
Adita Dwi Kirana
ANAK
03/04/2010
KENANGA
01/07/2015
AKTIF
19,225
23/06/2015
230
0001505867793 1901054107850015
14
SISMIYATI
PESERTA
01/07/1985
PEMALI
01/07/2015
AKTIF
19,225
23/06/2015
231
0001505867905 1901055310060003
14
ZELA OKTAVYANI
ANAK
13/10/2006
PEMALI
01/07/2015
AKTIF
19,225
23/06/2015
232
0001505868017 1901056106110001
14
PUTRISYA KHANSHA SYAFIRA ANAK
21/06/2011
PEMALI
01/07/2015
AKTIF
19,225
23/06/2015
233
0001505868129 1901056112130001
14
DELVYTA SARY
ANAK
21/12/2013
PEMALI
01/07/2015
AKTIF
19,225
23/06/2015
234
0001505867826 1901020708560004
142
MEN FO
PESERTA
08/07/1956
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
235
0001505867837 1901025005640001
142
SURIANA
ISTRI
05/10/1964
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
236
0001505867848 1901027012840004
142
YULIE
ANAK
30/12/1984
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
237
0001505867859 1901021709870005
142
SEPTIAWAN
ANAK
17/09/1987
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
238
0001505867861 1901022103900005
142
JEFFRY
ANAK
21/03/1990
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
239
0001505867872 1901022811910001
147
LIE LIE
PESERTA
28/11/1991
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
240
0001505867883 1901025606860001
148
PIPIT HANDAYANI
PESERTA
16/06/1986
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
241
0001505867894 1901022111670001
149
FOEK PHIN
PESERTA
21/11/1967
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
242
0001505867916 1901025601790001
149
NYUK SONG
ISTRI
16/01/1979
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
243
0001505867927 1901020401000001
149
RAVIKI
ANAK
01/04/2000
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
244
0001505867938 1901025894020001
149
REVITA DEWI NATARI
ANAK
18/04/2002
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
245
0001505867949 1901020301060001
149
RAVIANTO
ANAK
01/03/2006
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
246
0001505867951 1901023004540001
154
BOEN TJIN BONG
PESERTA
30/04/1954
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
247
0001505867962 1901026101640001
154
KHANG PHIN
ISTRI
21/01/1964
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
248
0001505867973 1901021809880001
154
DAVIT FERMANTO
ANAK
03/02/1988
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
249
0001505867984 1901022404490001
157
BOEN TJOEK
PESERTA
24/04/1949
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
12/2/15 3:15 PM
Page 11 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
250
0001505867995 1901022610590001
158
HASANUSI
PESERTA
26/10/1959
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
251
0001505868006 1901022909790005
159
SURYANTO
PESERTA
29/09/1979
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
252
0001505868028 1971016105850002
159
YUYUN ROSWANSYAH
ISTRI
21/05/1985
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
253
0001505868039 1901025304660001
161
SUHADA
PESERTA
22/04/1966
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
254
0001505868041 3216211305670005
162
ISKANDAR
PESERTA
13/05/1967
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
255
0001505868052 3216216307690001
162
ARWATI
ISTRI
23/07/1969
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
256
0001505868063 3216216506920004
162
ISTI FATIMAH
ANAK
25/06/1992
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
257
0001505868074 3216212108980003
162
DESTI FATMAWATI
ANAK
08/11/1998
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
258
0001505868085 1901022207850002
166
AMRAN WESENO
PESERTA
07/07/1980
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
259
0001505868096 1901024510850001
166
FAJAR SARI
ISTRI
10/05/1985
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
260
0001505868107 1901026912060001
166
YESY EKA SARI
ANAK
29/12/2006
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
261
0001505868118 1901024409110002
166
SYAFA DWI AULIA
ANAK
09/04/2011
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
262
0001505868131 1901020711730001
170
KARMINTO
PESERTA
11/07/1973
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
263
0001505868142 1901027101750002
170
RESTIA AMBAR SARI
ISTRI
31/01/1975
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
264
0001505868153 1901021910010001
170
JOWEIS ANGGARA PRAYOGA ANAK
19/10/2001
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
265
0001505868164 1901025207050001
170
GHETI DWINTA SUL PONDARI ANAK
07/12/2005
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
266
0001505868175 1901025602130001
170
HANNA ALIFAH
ANAK
26/02/2013
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
267
0001505868186 1901021810770001
175
SYAIFUL ASWIN
PESERTA
18/10/1977
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
268
0001505868197 1901024212800001
175
RATIH ARGASARI
ISTRI
12/02/1980
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
269
0001505868208 1901081201090001
175
ADIB FIRAAS GHATFAAN
ANAK
01/12/2009
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
270
0001505868219 1901021212740002
178
ERSANUDIN
PESERTA
12/12/1974
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
271
0001505868221 1901024102790003
178
JUMRIAH ALVIANI
ISTRI
02/01/1979
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
272
0001505868243 1901025608020001
178
ERSI SAVITRI
ANAK
16/08/2002
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
12/2/15 3:15 PM
Page 12 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
273
0001505868254 1901024910050002
178
TRI OKTARYANTI
ANAK
10/09/2005
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
274
0001505868265 1901020503110001
178
ERLANGGA KOHRI
ANAK
03/05/2011
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
275
0001505868232 1901015107040001
18
Anju Maharani Cahya Puspita
PESERTA
11/07/2004
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
276
0001505868276 1901026508760001
183
INDAH PRATIWI
PESERTA
25/08/1976
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
277
0001505868287 1901024504040001
183
GEYSA BASAYEVA
ANAK
04/05/2004
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
278
0001505868298 1901020203060004
183
MARIO REVELDO
ANAK
03/02/2006
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
279
0001505868309 1901021704720003
186
ZAINUDIN
PESERTA
17/04/1972
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
280
0001505868311 1901024505840006
186
MEILIASARI
ISTRI
05/05/1984
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
281
0001505868322 1901020810010004
186
ZEANLIZ
ANAK
10/08/2001
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
282
0001505868333 1901022610070002
186
HENDI SAPUTRA
ANAK
26/10/2007
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
283
0001505868355 1901024712100001
186
NASWHA
ANAK
12/07/2010
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
284
0001505868344 1901014405000001
19
LIANORI
PESERTA
04/04/1950
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
285
0001505868366 1901020205660001
191
DARSOYADI
PESERTA
05/02/1966
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
286
0001505868377 1901026505690001
191
SUPRIHATIN
ISTRI
25/05/1969
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
287
0001505868388 1901020908950003
191
AGUS RIYADI
ANAK
08/09/1995
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
288
0001505868399 1901026111050001
191
NOPI DWI DAMAYANTI
ANAK
21/11/2005
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
289
0001505868401 1901020104670001
195
SUYADI MADYO DIHARJO
PESERTA
04/01/1967
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
290
0001505868412 1901024303720001
195
MARDINI
ISTRI
03/03/1972
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
291
0001505868423 1901026712990003
195
DESI WULAN SUCI
ANAK
27/12/1999
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
292
0001505868434 1901021201030001
195
MUHAMMAD SAHID ABDULLAH ANAK
01/12/2003
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
293
0001505868445 1901021009500022
199
SUDIONO
PESERTA
09/10/1950
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
294
0001505868478 1901025206620025
199
SARMUNAH
ISTRI
06/12/1962
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
295
0001505868489 1901020805800001
199
ADI SUSANTO
ANAK
05/08/1980
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
12/2/15 3:15 PM
Page 13 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
296
0001505868491 1901020206830002
199
HAIRUL GUSTIO
ANAK
06/02/1983
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
297
0001505868467 1901012805770001
20
Ani
PESERTA
28/05/1977
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
298
0001505868502 1901024909580001
203
NURANI
PESERTA
09/09/1958
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
299
0001505868513 1901024811420001
204
GINDUNG
PESERTA
11/08/1942
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
300
0001505868524 1901024803640001
204
RUSYANTI
ANAK
03/08/1964
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
301
0001505868535 1901020308760003
206
USMAN
PESERTA
08/03/1976
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
302
0001505868546 1901025602760001
206
ACHDIAWATI
ISTRI
16/02/1976
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
303
0001505868557 1901021010000003
206
ABDUL ROZALI
ANAK
10/10/2000
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
304
0001505868568 1901020104060001
206
ABDUL HAFIZ
ANAK
04/01/2006
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
305
0001505868581 1901024708090003
206
ADINDA ZAHIRAH
ANAK
08/07/2009
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
306
0001505868579 1901010405440005
21
Nana Adenan
PESERTA
04/05/1944
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
307
0001505868592 1901020709500001
211
SURYANTO
PESERTA
09/07/1950
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
308
0001505868603 1901020107800039
211
MEDI HARTONO
ANAK
07/01/1980
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
309
0001505868614 1901021305920001
211
MERIKAL
ANAK
13/05/1992
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
310
0001505868625 1901021211630002
214
SAFRI
PESERTA
11/12/1963
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
311
0001505868636 1901022205680001
215
MAS AGUS MARZUKI
PESERTA
21/05/1968
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
312
0001505868647 1901024910710001
215
ROSMITA
ISTRI
10/08/1971
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
313
0001505868658 1901025108040003
215
MAS AYU AL'AINAUL MARDIAH ANAK
08/11/2004
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
314
0001505868669 1901021102670002
218
HORMEN
PESERTA
02/11/1967
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
315
0001505868671 1901026401700001
218
MISRA
ISTRI
24/01/1970
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
316
0001505868693 1901025805970003
218
HERIYANA
ANAK
18/05/1997
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
317
0001505868704 1901020212980001
218
DANDI ARDIANSAH
ANAK
12/02/1998
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
318
0001505868715 1901025505030003
218
SRI RAHAYU
ANAK
15/06/2003
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
12/2/15 3:15 PM
Page 14 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
319
0001505868682 1901011211970005
22
Adsya Putra
PESERTA
12/11/1997
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
320
0001505868726 1901021107750001
223
DARWIS DARMA JAYA
PESERTA
07/11/1975
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
321
0001505868737 1901024902750003
223
TRI VENIARSIH
ISTRI
02/09/1975
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
322
0001505868748 1901021307000001
223
HABIB AL MUQOROBBUN
ANAK
13/07/2000
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
323
0001505868759 1901020610020001
223
OKTA FIRDAUS
ANAK
10/06/2002
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
324
0001505868761 1901020608680003
227
MUHAMAD
PESERTA
08/06/1968
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
325
0001505868772 1901025606740003
227
ANITA
ISTRI
16/06/1974
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
326
0001505868783 1901021404960001
227
BUANA SAPUTRA
ANAK
04/12/1996
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
327
0001505868805 1901025909990001
227
OVI DWIDIYAM RIZKI
ANAK
14/11/1998
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
328
0001505868816 1901024903030004
227
SAHARA ELZANTI
ANAK
03/09/2003
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
329
0001505868794 1901015809950006
23
Robi Ayuliyani
PESERTA
18/09/1995
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
330
0001505868827 1901025608660001
232
ROSIAH
PESERTA
16/08/1966
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
331
0001505868838 1901020804970003
232
PIKO APRIYANSA
ANAK
04/08/1997
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
332
0001505868849 1901022801030002
232
JANGGU PRATAMA
ANAK
28/01/2003
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
333
0001505868851 1901020212060002
232
DANIL
ANAK
12/02/2006
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
334
0001505868862 1901021302770002
236
FERRY FAHRIZAL
PESERTA
13/02/1977
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
335
0001505868873 1901025008790002
236
BUNNAYA
ISTRI
08/10/1979
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
336
0001505868884 1901022804030003
236
ISMED ARDIYANSYAH
ANAK
28/04/2003
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
337
0001505868895 1901022312070001
236
ILHAM PERDINA
ANAK
23/12/2007
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
338
0001505868906 1901012712720001
24
Alias Bin Papait
PESERTA
27/12/1972
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
339
0001505869018 1901015108750002
24
Hernani
ISTRI
08/11/1975
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
340
0001505869121 1901016904990001
24
Atika Putriani
ANAK
29/04/1999
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
341
0001505869233 1901012509000001
24
Wahyudistira
ANAK
25/09/2000
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
12/2/15 3:15 PM
Page 15 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
342
0001505869345 1901012410040001
24
Idristira
ANAK
24/10/2004
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
343
0001505868917 1901025208810002
240
MARIANA
PESERTA
08/12/1981
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
344
0001505868928 1901025012640003
241
TJHANG DJUN HIONG
PESERTA
12/10/1954
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
345
0001505868939 1901021803880001
241
FUT JAN
ANAK
18/03/1988
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
346
0001505868941 1901021309610001
243
ROSIDI
PESERTA
13/09/1961
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
347
0001505868952 1901026512640002
243
KRISNAWATI
ISTRI
25/12/1964
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
348
0001505868963 1901025511910001
243
NOVA RADITA
ANAK
15/11/1991
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
349
0001505868974 1901020910940002
243
RIYANTO SAPUTRA
ANAK
10/09/1994
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
350
0001505868985 1901022907010002
243
RONALDO JULIANTO
ANAK
29/07/2001
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
351
0001505868996 1901022909890006
248
PERPIJOS
PESERTA
29/09/1989
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
352
0001505869007 1901022508550002
249
SORE
PESERTA
25/08/1955
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
353
0001505869029 1901020606710001
250
QOMARUDDIN
PESERTA
06/06/1971
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
354
0001505869031 1901026206720001
250
HARIYANTI
ISTRI
22/06/1972
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
355
0001505869042 1901021310960001
250
YOGI SAPUTRA
ANAK
13/10/1996
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
356
0001505869053 1901024312970001
250
YOVANA PRATIWI
ANAK
12/03/1997
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
357
0001505869064 1901026412040001
250
YORI PRADINANTI
ANAK
24/12/2004
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
358
0001505869075 1901021602790001
255
DIDI CANDRA
PESERTA
16/02/1979
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
359
0001505869086 1901024411760001
255
PIT SIAN
ISTRI
11/04/1976
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
360
0001505869097 1901022310000002
255
IVANDI PUTRA
ANAK
23/10/2000
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
361
0001505869108 1901020810060001
255
ADITYA ELGA
ANAK
10/08/2006
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
362
0001505869119 1901021501610001
259
MASYURI
PESERTA
15/01/1961
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
363
0001505869132 1901021307620001
260
FOE SIONG SIN
PESERTA
13/07/1962
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
364
0001505869143 1901025611640001
260
DJIE SIU FA
ISTRI
16/11/1964
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
12/2/15 3:15 PM
Page 16 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
365
0001505869154 1901021708000001
260
AGUS PROWANTO
ANAK
17/08/2000
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
366
0001505869165 1901023009660001
263
LO TOENG FO
PESERTA
30/09/1966
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
367
0001505869176 1901024106750002
263
SURATI
ISTRI
15/07/1975
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
368
0001505869187 1901020807920002
263
HENDRA JAYA
ANAK
07/08/1992
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
369
0001505869198 1901024806940004
263
CHERLINE OCTAVIA
ANAK
06/08/1994
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
370
0001505869209 1901020808570002
267
TJHAUW DJOEN KHIONG
PESERTA
08/08/1957
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
371
0001505869211 1901024703600002
267
PHANG SOENG LIAN
ISTRI
03/07/1960
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
372
0001505869222 1901025307860002
267
ANJELINA
ANAK
13/07/1986
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
373
0001505869244 1901021304890002
267
APRIYANTO
ANAK
13/04/1989
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
374
0001505869255 1901020710900002
267
OKTAVIANUS DEDDY
ANAK
10/07/1990
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
375
0001505869266 1901022307720001
272
DJONG FO
PESERTA
23/07/1972
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
376
0001505869277 1901022506750001
272
MIN KHIONG
ISTRI
25/06/1975
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
377
0001505869288 1901022005520001
274
DJUN FO
PESERTA
20/05/1952
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
378
0001505869299 1901026108580001
274
TJONG PIT TJI
ISTRI
21/08/1958
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
379
0001505869301 1901021401920001
274
TRI HANDOKO
ANAK
14/01/1992
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
380
0001505869312 1901024304940002
274
VERA VERONIKA
ANAK
04/03/1994
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
381
0001505869323 1901021803970001
274
LEO ARMANDO
ANAK
18/03/1997
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
382
0001505869334 1901020307760001
279
LIONG SIOE LOI
PESERTA
07/03/1976
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
383
0001505869356 1901024406730001
279
PHAN SOEI LIONG
ISTRI
06/04/1973
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
384
0001505869367 1901020102960003
279
A HIUNG
ANAK
02/01/1996
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
385
0001505869378 1901024101460001
282
HASNAH
PESERTA
01/01/1946
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
386
0001505869389 1901024107390018
283
AMINAH
PESERTA
07/01/1939
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
387
0001505869391 1901025403600003
283
MARLINA
ANAK
14/03/1960
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
12/2/15 3:15 PM
Page 17 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
388
0001505869402 1901025210620001
285
ROHANA
PESERTA
10/12/1962
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
389
0001505869413 1901024209000001
285
ROSITA
ANAK
09/02/2000
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
390
0001505869424 1901020306710001
287
JUNAIDI FAISAL
PESERTA
06/03/1971
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
391
0001505869435 1901026704780001
287
KARMILA
ISTRI
27/04/1978
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
392
0001505869446 1901026808050001
287
TIARA CAHYA PUTRI
ANAK
28/08/2005
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
393
0001505869468 1901024812070003
287
VIONA DWI PUTRI
ANAK
12/05/2007
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
394
0001505869479 1901025111110001
287
JUWITA FAISAL
ANAK
11/11/2011
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
395
0001505869457 1901011401010003
29
Jaya Sitanggang
PESERTA
14/01/2001
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
396
0001505869481 1901020205740004
292
FUNG JUN FUI
PESERTA
05/02/1974
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
397
0001505869492 1901022409620001
293
FOEK KHIONG
PESERTA
24/09/1962
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
398
0001505869503 1901024209760001
293
TITIK
ISTRI
09/02/1976
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
399
0001505869514 1901026508290001
295
CICILIA
PESERTA
25/08/1929
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
400
0001505869525 1901026506510028
296
LIM KIM HIONG
PESERTA
25/06/1951
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
401
0001505869536 1901020108770000
296
ANDRE CHANDRA
ANAK
08/01/1977
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
402
0001505869547 1901022404810001
296
SUGITO
ANAK
24/04/1981
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
403
0001505869558 1901021005830041
296
ALI
ANAK
05/10/1983
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
404
0001505869571 1901012104540002
30
Maslim Boentar
PESERTA
21/04/1954
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
405
0001505869683 1901015804570005
30
Siu Kuk
ISTRI
18/04/1957
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
406
0001505869795 1901016603830009
30
Susanna
ANAK
26/03/1983
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
407
0001505869907 1901010807840008
30
Susanto Bun
ANAK
07/08/1984
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
408
0001505870019 1901015402880010
30
Susanty
ANAK
14/02/1988
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
409
0001505869582 1901026001720001
300
SIOE LIE
PESERTA
20/01/1972
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
410
0001505869593 1901026909470002
301
TJOAI SO MOEI
PESERTA
29/09/1947
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
12/2/15 3:15 PM
Page 18 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
411
0001505869604 1901026412480002
302
ASMARA MURNI
PESERTA
24/12/1948
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
412
0001505869615 1901020110740004
303
TAUFIK HIDAYAT
PESERTA
10/01/1974
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
413
0001505869626 1901021312720001
304
ZALHAQI
PESERTA
13/12/1972
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
414
0001505869637 1901024801750001
304
ZAHARA
ISTRI
01/08/1975
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
415
0001505869648 1901025502090001
304
KAFKA NAVISA PUTRI
ANAK
15/02/2009
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
416
0001505869659 1901022612980001
307
RAMDHAN PUTRA RAMDHAN
PESERTA
26/12/1998
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
417
0001505869661 1901024912290001
308
BOEN SOEI THIN
PESERTA
12/09/1929
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
418
0001505869672 1901024101300001
309
TJHAUW KIE NIO
PESERTA
12/09/1930
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
419
0001505869694 1901020602820001
310
ALJAMI
PESERTA
02/05/1982
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
420
0001505869705 1901025401870003
310
KURNIATI
ISTRI
14/01/1987
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
421
0001505869716 1901022607060001
310
M. RIAN PRATAMA
ANAK
26/07/2006
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
422
0001505869727 1901020307100001
310
MUHAMMAD ZOFIE
ANAK
07/03/2010
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
423
0001505869738 1901026004140001
310
NAOMI SAFELLIA
ANAK
20/04/2014
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
424
0001505869749 1901021801750001
315
JUN PIN
PESERTA
18/01/1975
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
425
0001505869751 1901025607690003
315
LINDA
ISTRI
16/07/1969
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
426
0001505869762 1901021503000001
315
ALPANDI MILIANO
ANAK
15/03/2000
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
427
0001505869773 1901021205040003
315
DANIEL
ANAK
05/12/2004
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
428
0001505869784 1901020611100003
315
NIKO
ANAK
11/06/2010
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
429
0001505869806 1901025308930003
320
YULIVIANTI
PESERTA
13/08/1993
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
430
0001505869817 1901020706720001
321
TONNY GUNADI, TJEUW
PESERTA
06/07/1972
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
431
0001505869828 1901025412770001
321
LILY
ISTRI
14/12/1977
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
432
0001505869839 1901021008000003
321
JOHAN
ANAK
08/10/2000
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
433
0001505869841 1901021808020001
321
GUSTIAWAN
ANAK
18/08/2002
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
12/2/15 3:15 PM
Page 19 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
434
0001505869852 1901025312060001
321
DESTRIA ANGNES MONICA
ANAK
13/12/2006
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
435
0001505869863 1901022508710001
326
FO SIONG FO
PESERTA
25/08/1971
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
436
0001505869874 1901026612730001
326
PIT SIOE DJIN
ISTRI
26/12/1973
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
437
0001505869885 1901023110970002
326
AHIUNG YOGI OKTADI
ANAK
31/10/1997
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
438
0001505869896 1901027011010001
326
DENISE PATRICIA
ANAK
30/11/2001
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
439
0001505869918 1901022504040001
326
LIONARDO
ANAK
25/04/2004
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
440
0001505869929 1901020808700005
331
SIOE KHIONG
PESERTA
08/08/1970
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
441
0001505869931 1901024308340001
332
SOPIAH
PESERTA
08/03/1934
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
442
0001505869942 1901024112570007
333
NURMI
PESERTA
12/01/1957
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
443
0001505869953 1901023005760001
333
BAMBANG SUGIARTO
ANAK
30/05/1976
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
444
0001505869964 1901022707520002
335
ASLI ARAS
PESERTA
27/07/1952
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
445
0001505869975 1901024710570001
335
SUDARMA
ISTRI
10/07/1957
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
446
0001505869986 1901026204060002
337
NABILA APRILIA
PESERTA
22/04/2006
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
447
0001505869997 1901023107970001
338
RIZQI MAGHRIBIARSYAH
PESERTA
31/07/1997
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
448
0001505870008 1901022512720003
339
MERI KUSMIRAN
PESERTA
25/12/1972
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
449
0001505870021 1901025603830003
339
RENI MARYANI
ISTRI
16/03/1983
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
450
0001505870032 1902026204050003
339
RAHMAN MAULIDAH
ANAK
22/04/2005
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
451
0001505870043 1901020401070001
339
ABDURRAHMAN
ANAK
01/04/2007
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
452
0001505870054 1901020806090001
339
MUSLIMAH
ANAK
18/06/2009
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
453
0001505870065 1901022501860003
344
SUCIPTO
PESERTA
25/01/1986
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
454
0001505870076 1971054510800003
344
ELIS CORNELIS
ISTRI
10/05/1980
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
455
0001505870087 1901026005030010
344
MEISI MARVIZANOVA
ANAK
20/05/2003
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
456
0001505870098 1901025809130003
344
SULISTIA AZZAHRA
ANAK
18/09/2013
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
12/2/15 3:15 PM
Page 20 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
457
0001505870109 1901024306580002
348
JAMNAH
PESERTA
03/06/1958
BELINYU
01/07/2015
AKTIF
19,225
23/06/2015
458
0001505870111 1901014503670002
35
Risnawati
PESERTA
03/05/1967
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
459
0001505870122 1901011112970005
36
Bong Sui Tjon
PESERTA
22/08/1953
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
460
0001505870133 1901011702730001
37
Merri
PESERTA
17/02/1973
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
461
0001505870144 1901011211550001
38
Syafril
PESERTA
11/12/1955
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
462
0001505870155 1901011505840001
38
Imam Wahyudi
ANAK
15/05/1984
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
463
0001505870177 1901012604890001
38
Muhammad Al Anfal
ANAK
26/04/1989
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
464
0001505870188 1901010803930001
38
Yudha Al Fajri
ANAK
03/06/1993
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
465
0001505870199 1901012707680001
42
TJHIN DJUN KHIONG
PESERTA
27/07/1968
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
466
0001505870201 1901015702730001
42
MERRI
ISTRI
17/02/1973
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
467
0001505870212 1901012906980001
42
STEVAN JUNIVEN
ANAK
29/06/1998
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
468
0001505870223 1901010411300003
45
TJEN KON HOU
PESERTA
11/04/1930
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
469
0001505870234 1901015711550002
45
TJEN TJHOEN JING
ANAK
17/11/1955
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
470
0001505870245 1901016908410002
47
TJHIN SIN TJAI
PESERTA
29/08/1941
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
471
0001505870256 1901011008330001
48
BOEN DJOENG KIM
PESERTA
08/10/1933
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
472
0001505870267 1901015006410001
48
TJUNGIAN NGO
ISTRI
06/10/1941
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
473
0001505870289 1901010507800005
50
INDRA
PESERTA
07/05/1980
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
474
0001505870291 1901016606750003
50
SERIANI
ISTRI
26/06/1975
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
475
0001505870302 1901014405050002
50
PUTRI MEILINDA PUSPITA

SARI
ANAK
05/04/2005
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
476
0001505870313 1901016708090001
50
FITRI RAMADANI
ANAK
27/08/2009
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
477
0001505870324 1901016706120001
50
SALWA AYU PUTRI
ANAK
27/06/2012
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
478
0001505870335 1904014607790002
55
ZUBAIDAH
PESERTA
06/07/1979
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
479
0001505870357 1901010808650002
57
ROSITA
PESERTA
30/06/1961
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
12/2/15 3:15 PM
Page 21 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
480
0001505870368 1901010108590002
58
AGUSCIK
PESERTA
08/01/1959
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
481
0001505870379 1901012607910003
59
RIZAL GILANG PERKASA
PESERTA
26/07/1991
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
482
0001505870392 1901013009950004
59
DWIKKY SAKTI SANUSI PUTRA ANAK
30/09/1994
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
483
0001505870403 1901016606980001
59
GABRIELAZAZA MONICA
ANAK
26/06/1998
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
484
0001505870414 1901012005050003
59
GIBRAN BANGKIT ANUGRAH
ANAK
20/05/2005
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
485
0001505870381 1901050801960003
DARMADI
PESERTA
08/01/1996
PEMALI
01/07/2015
AKTIF
19,225
23/06/2015
486
0001505870493 1901055411980001
PUTRI SUHARTATI
ISTRI
14/11/1998
PEMALI
01/07/2015
AKTIF
19,225
23/06/2015
487
0001505870425 1901015603630001
63
ELVIZAH
PESERTA
16/03/1963
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
488
0001505870436 1901011805770006
64
MISTO LUMBAN GAOL
PESERTA
18/05/1977
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
489
0001505870447 1901014306810002
64
JUNITA
ISTRI
06/03/1981
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
490
0001505870458 1901014104090001
64
KRISTY LUMBAN GAOL
ANAK
04/01/2009
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
491
0001505870469 1901010504110005
64
HANSEN LUMBAN GAOL
ANAK
04/05/2011
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
492
0001505870471 1901012512730005
68
HARAPAN SAMOSIR
PESERTA
25/12/1973
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
493
0001505870482 1901017011770007
68
ARTHA SIBAGARIANG
ISTRI
30/11/1977
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
494
0001505870504 1901010912000002
68
FREDY SAMOSIR
ANAK
12/09/2000
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
495
0001505870515 1901011305040001
68
JONATHAN SAMOSIR
ANAK
13/05/2004
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
496
0001505870526 1901011111120003
68
FELIX GEMELIO SAMOSIR
ANAK
11/11/2012
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
497
0001505870537 1901012410710001
73
HERRY SISWANTO
PESERTA
24/10/1971
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
498
0001505870548 1901014908760004
73
MELYANI
ISTRI
08/09/1976
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
499
0001505870559 1901010606950004
73
FIKRI BAROKA
ANAK
06/06/1995
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
500
0001505870561 1901010312000005
73
FAHMI DISTIANTO
ANAK
12/03/2000
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
501
0001505870572 1901011612020002
73
YUDISTIRA
ANAK
16/12/2002
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
502
0001505870583 1901011003630001
78
A. FITRI
PESERTA
03/10/1963
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
12/2/15 3:15 PM
Page 22 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
503
0001505870594 1901015606690005
78
JUNIYARTI
ISTRI
16/06/1969
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
504
0001505870616 1901015212960001
78
DESI MEFIKASARI
ANAK
12/12/1996
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
505
0001505870627 1901012112990004
78
DEDET HARYANNI
ANAK
21/12/1999
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
506
0001505870605 1901052109770002
TEJO SUSILO
PESERTA
21/09/1977
PEMALI
01/07/2015
AKTIF
19,225
23/06/2015
507
0001505870717 1901054510900004
NURHAYATI
ISTRI
05/10/1990
PEMALI
01/07/2015
AKTIF
19,225
23/06/2015
508
0001505870638 1901011906600003
82
EFFENDI
PESERTA
19/06/1960
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
509
0001505870649 1901015002650003
82
HOLILAH
ISTRI
02/10/1965
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
510
0001505870651 1901011501990004
82
DANDY HARTONO
ANAK
15/01/1999
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
511
0001505870662 1901010809840001
85
KIKI NURYADI
PESERTA
09/08/1984
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
512
0001505870673 1901011706690001
86
Supiie
PESERTA
17/06/1969
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
513
0001505870684 1901014207490001
86
Tatik Sukaisih
ISTRI
02/07/1949
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
514
0001505870695 1901014904370001
88
Phung Nyuk Bui
PESERTA
09/04/1937
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
515
0001505870706 1901011410640004
88
Phung Shak Lie
ANAK
14/10/1964
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
516
0001505870728 1901011309660001
88
Phung Muk Fa
ANAK
13/09/1966
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
517
0001505870739 1901014701600018
91
Piyah
PESERTA
07/01/1960
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
518
0001505870741 1901014211500002
92
Mariyam
PESERTA
02/11/1950
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
519
0001505870752 1901010702710003
92
Sapri
ANAK
07/02/1971
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
520
0001505870763 1901016308490001
94
Ica
PESERTA
23/08/1949
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
521
0001505870774 1901012710570003
95
M.Hapizin
PESERTA
27/10/1957
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
522
0001505870785 1901010505490003
96
Sabirin Lihan
PESERTA
05/05/1949
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
523
0001505870796 1901015403520001
96
Zubaini
ISTRI
14/03/1952
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
524
0001505870807 1901011309780003
96
Suwandi
ANAK
13/09/1978
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
525
0001505870818 1901012108650001
99
Suhardi
PESERTA
21/08/1965
SUNGAILIAT
01/07/2015
AKTIF
19,225
23/06/2015
12/2/15 3:15 PM
Page 23 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
526
0001506210491 1901024403920002
SENI SANTIA
PESERTA
04/03/1992
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
527
0001506210502 1901024609480003
SUDARMAN
PESERTA
06/09/1948
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
528
0001506210513 1901025607630003
SRI MIRAYATI
ISTRI
16/07/1963
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
529
0001506210524 1901021701760001
ARWIN
PESERTA
17/01/1976
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
530
0001880177556 1901021107850002
AGUS PITRIYANTO
TAMBAHAN
11/07/1995
BELINYU
01/09/2015
AKTIF
19,225
25/08/2015
531
0001506210535 1901026810750003
FUT HO
PESERTA
28/10/2001
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
532
0001880182113 1901021901010002
STEVEN ENGRIAWAN
TAMBAHAN
19/01/2001
BELINYU
01/09/2015
AKTIF
19,225
25/08/2015
533
0001506210546 1901020302940001
FEBRI KRISWIDIANTORO
PESERTA
03/02/1994
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
534
0001506210557 1901026111820001
NURAIDA
PESERTA
21/11/1982
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
535
0001880186589 1901024910860004
SUGIARTI
TAMBAHAN
09/10/1986
BELINYU
01/09/2015
AKTIF
19,225
25/08/2015
536
0001506210568 1901020110430004
MOK MUK SUI
PESERTA
01/10/1943
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
537
0001880188683 1901021511860003
SUTOLI
ANAK
15/11/1986
BELINYU
01/09/2015
AKTIF
19,225
25/08/2015
538
0001506210579 1901021808630001
KIAN SAN
PESERTA
18/08/1963
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
539
0001506210581 1901026012660002
SULASTRI
ISTRI
20/12/1966
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
540
0001506210592 1901026807000001
FITHA JULIANA
ANAK
28/07/2000
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
541
0001506210603 1901025112580002
12
SUTIA
PESERTA
12/11/1958
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
542
0001506210614 1901026203440001
13
NURSAMA
PESERTA
22/03/1944
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
543
0001506210625 1901027112450002
14
HANIPAH
PESERTA
31/12/1945
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
544
0001506210636 1901027011360001
15
JANAH
PESERTA
30/11/1936
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
545
0001506210647 1901021507570001
16
HAMIDAH
PESERTA
15/07/1957
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
546
0001506210658 1901025510010002
16
OKTA RISTIANI
ANAK
15/10/2001
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
547
0001506210669 1901025312700001
18
SUNITA
PESERTA
13/12/1970
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
548
0001506210671 1901022605980002
18
BANGGA PUTRA PRIANTO
ANAK
26/05/1998
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
12/2/15 3:15 PM
Page 24 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
549
0001506210682 1901021408050001
18
GURKA GUSPRIYANTO
ANAK
14/08/2005
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
550
0001506210693 1901024107410008
21
HASMAH
PESERTA
07/01/1941
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
551
0001506210704 1901020104520001
22
HASAN DERONI
PESERTA
04/01/1952
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
552
0001506210715 1901024507550002
22
SAUNAH
ISTRI
07/05/1955
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
553
0001506210726 1901024808590003
24
JUBAI
PESERTA
08/08/1959
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
554
0001506210737 1901022907030001
24
ARIFIN
ANAK
29/07/2003
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
555
0001506210748 1901021606620002
26
SUKIRA
PESERTA
16/06/1962
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
556
0001506210759 1901024806660003
26
SUMIATI
ISTRI
08/06/1966
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
557
0001506210761 1901026203630002
28
YANA
PESERTA
22/03/1963
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
558
0001506210772 1901022511950002
30
REDO PRATAMA
PESERTA
25/11/1995
BELINYU
01/09/2015
AKTIF
19,225
20/08/2015
559
0001506210783 1901035111860002
31
SUMASNA
PESERTA
11/11/1986
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
560
0001506210794 1901036005630001
32
NAM FA
PESERTA
27/02/1963
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
561
0001506210805 1901036404660002
33
HAYATI
PESERTA
24/04/1966
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
562
0001880204859 1901030211940001
33
MUAMMAR
ANAK
11/02/1994
BATURUSA
01/09/2015
AKTIF
19,225
25/08/2015
563
0001506210816 3602011009700004
34
ADRIYAN
PESERTA
10/10/1970
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
564
0001506210827 3602014204740002
34
NAPISAH
ISTRI
04/02/1974
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
565
0001506210838 1901030107840025
36
SUMARLI
PESERTA
01/07/1984
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
566
0001506210849 1901034107860028
36
NADEH
ISTRI
01/07/1986
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
567
0001506210851 3527080107812217
38
MARJU'E
PESERTA
01/07/1981
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
568
0001506210862 3527085007832306
38
SU'ADEH
ISTRI
07/10/1983
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
569
0001506210873 3526100107831230
40
SURI
PESERTA
07/01/1983
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
570
0001506210884 3526104607850001
40
MISRI
ISTRI
07/06/1985
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
571
0001506210895 3526172203850002
42
M. KHOLIL
PESERTA
22/03/1985
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
12/2/15 3:15 PM
Page 25 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
572
0001506210906 3526175102890004
42
SAPIYEH
ISTRI
02/11/1989
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
573
0001506210917 1901032012780002
44
SETUKI
PESERTA
20/12/1978
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
574
0001506210928 1901034805690003
44
MONA
ISTRI
05/08/1969
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
575
0001506210939 1901030107850031
46
MISKI
PESERTA
07/01/1985
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
576
0001506210941 3203184108960009
46
HALIMAH
ANAK
08/01/1996
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
577
0001506210952 1901032508800001
48
BUDI ARIANTO
PESERTA
25/08/1980
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
578
0001506210963 1901035304620001
48
TAI ANYONG
ISTRI
13/04/1962
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
579
0001506210974 1804024508640003
50
PAULINA
PESERTA
08/05/1964
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
580
0001506210985 1901032605550001
51
TJEN NGIAN DJANG
PESERTA
26/05/1955
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
581
0001506210996 1901035701630002
52
DJUN TJIAUW
PESERTA
17/01/1963
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
582
0001506211007 1901037012870001
53
ELISABET
PESERTA
30/12/1987
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
583
0001506211018 1901034612620001
54
LIE FA HIONG
PESERTA
12/06/1952
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
584
0001506211029 1901031012610001
55
SUTRISNO
PESERTA
12/10/1961
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
585
0001506211031 3306127077700007
55
PONIYEM
ISTRI
07/07/1977
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
586
0001506211042 1901031610690001
57
TJHIN TIU TIU
PESERTA
16/10/1969
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
587
0001506211053 1901037012560002
58
BONG SO EIJ HIONG
PESERTA
30/12/1956
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
588
0001506211064 1901032101480001
59
TJAUW KWET
PESERTA
21/01/1948
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
589
0001506211075 1901030508520001
60
BUN A THEN
PESERTA
09/05/1952
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
590
0001506211086 1901035406530001
60
DJAP NGIT NON
ISTRI
14/06/1953
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
591
0001506211097 1901036710540002
62
SOEI JOEN
PESERTA
27/10/1954
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
592
0001506211108 1901030310410001
63
LIE A NGIAT
PESERTA
10/03/1941
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
593
0001506211119 1901034603590001
64
TJUNG SUI MIE
PESERTA
03/06/1959
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
594
0001506211121 1901035601330002
65
KASMA
PESERTA
16/01/1933
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
12/2/15 3:15 PM
Page 26 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
595
0001506211132 1901035604820003
66
SAK LIM
PESERTA
14/04/1982
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
596
0001506211143 1901035002300001
67
BUN DJUNG HIE
PESERTA
02/10/1930
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
597
0001506211154 1901031203540001
68
SIRI
PESERTA
03/12/1954
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
598
0001506211165 1901030507720001
69
SAFI'I BIN NURKIYAN
PESERTA
07/05/1972
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
599
0001506211176 1901034310710003
70
SANINTEN
PESERTA
04/02/1976
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
600
0001506211187 1901031902820001
71
MANSUR .S
PESERTA
19/02/1982
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
601
0001506211198 1901030107730020
72
BAHAS
PESERTA
04/10/1968
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
602
0001506211209 1901035503850002
73
MARNA
PESERTA
15/03/1985
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
603
0001506211211 3526174107870602
74
ROHEMAH
PESERTA
06/01/1987
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
604
0001506211222 1901035504770001
75
SITI MARIYE
PESERTA
15/04/1977
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
605
0001506211233 1901032211950001
76
HAL ANDIANSYAH
PESERTA
22/11/1995
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
606
0001506211244 6112014207880016
77
EKA NINGSIH
PESERTA
11/02/1988
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
607
0001506211255 1901035908980001
78
MARDILA
PESERTA
02/10/1997
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
608
0001506211266 1901034706850002
79
LIHA
PESERTA
06/07/1985
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
609
0001506211277 1901034606900004
80
HOLIAH
PESERTA
06/06/1990
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
610
0001506211288 1901035701830001
81
RODIAH
PESERTA
17/01/1983
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
611
0001506211299 1901035112880002
82
DESI ARYONO
PESERTA
12/11/1988
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
612
0001506211301 1901032006790003
83
PONIDIN
PESERTA
20/06/1979
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
613
0001506211312 1901034107840022
83
SURAH
ISTRI
07/01/1984
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
614
0001506211323 1901030607740002
85
KAPRAWI
PESERTA
07/06/1974
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
615
0001506211334 1901034808840002
86
MISTINA
PESERTA
08/08/1984
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
616
0001506211345 1901031004890002
87
SAMSURI
PESERTA
04/10/1989
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
617
0001506211356 1901035004930001
87
ROMIATI
ISTRI
04/10/1993
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
12/2/15 3:15 PM
Page 27 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
618
0001506211367 1901035802900002
89
EVI PURNAMASARI
PESERTA
18/02/1990
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
619
0001506211378 1901030908860002
90
AGUS RIAN DESTRIANTO
PESERTA
08/09/1986
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
620
0001506211389 1901036305780001
91
MISYATI
PESERTA
11/09/1977
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
621
0001506211391 1901031501880001
92
ALFIAN
PESERTA
15/01/1988
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
622
0001506211402 1901030904860002
93
IWAN KUSUMA JAYA
PESERTA
04/09/1986
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
623
0001506211413 1901034903890002
93
MARETA
ISTRI
03/09/1989
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
624
0001506211424 1901034701790007
95
ROMIYAH
PESERTA
01/07/1979
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
625
0001506211435 1901035408830003
96
NINTI
PESERTA
14/08/1985
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
626
0001506211446 1901034107860023
97
MARLENA
PESERTA
07/01/1986
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
627
0001506211457 1901035303620001
98
NISA
PESERTA
13/03/1962
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
628
0001506211468 1901031807820004
99
TASIK
PESERTA
18/07/1962
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
629
0001506211479 1901031307730001
100
MINO BIN SIRAT
PESERTA
10/08/1974
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
630
0001506211481 1901030110880005
101
DEDI SETIAWAN
PESERTA
10/01/1988
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
631
0001506211492 1901031503910001
102
RIRIN
PESERTA
15/03/1991
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
632
0001506211503 1901031310740001
103
MUK HIN
PESERTA
13/10/1974
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
633
0001506211514 1901035006760001
103
MARIA FRANSISKA
ISTRI
10/05/1976
BATURUSA
01/09/2015
AKTIF
19,225
20/08/2015
634
0001506211525 1901010701690001
105
TJHIN KIONG
PESERTA
07/01/1969
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
635
0001506211536 1901014812690001
105
SUI YIN
ISTRI
08/12/1969
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
636
0001506211547 1901016310030001
105
TIARA
ANAK
23/10/2003
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
637
0001506211558 1901010405400000
108
TJHIN NAM FU
PESERTA
04/05/1940
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
638
0001506211569 1901052905690001
109
TJHIN SOEI TJHIANG
PESERTA
29/05/1959
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
639
0001506211571 1901062207700002
109
NG KIOEN LIANG
ISTRI
22/07/1970
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
640
0001506211582 1901012606410001
111
LUKAS LUSI
PESERTA
26/06/1941
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
12/2/15 3:15 PM
Page 28 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
641
0001506211593 1901014702440001
111
NG NJUK LOI
ISTRI
07/02/1944
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
642
0001506211604 1901010401770003
113
BUN KIM WEN
PESERTA
04/01/1977
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
643
0001506211615 1901016201810001
113
TJHANG SUE CHEN
ISTRI
22/01/1981
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
644
0001506211626 1901015803022005
113
MARSELLA LAVIOLA
ANAK
18/03/2002
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
645
0001506211637 1901012607030002
113
JONI MONTELLA
ANAK
26/07/2003
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
646
0001506211648 1901012907070002
113
KEVIN CHANIAGO
ANAK
29/07/2007
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
647
0001506211659 1901011508720001
118
TJUNG MUK MIN
PESERTA
15/08/1972
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
648
0001506211661 1901016102770003
118
MIE HON
ISTRI
21/02/1977
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
649
0001506211672 1901016059900005
118
FRENKI
ANAK
16/05/1999
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
650
0001506211683 1901027100000003
118
FRENDO
ANAK
27/10/2000
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
651
0001506211694 1901059030700008
118
JUWITA
ANAK
19/03/2007
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
652
0001506211705 1901014303890003
123
DELIETA
PESERTA
03/03/1989
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
653
0001506211716 1901016712110001
123
LETISIA
ANAK
27/12/2011
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
654
0001506211727 1901016805140008
123
VIRNI
ANAK
28/05/2014
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
655
0001506211738 1901016805140005
123
VIRLI
ANAK
28/05/2014
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
656
0001506211749 1901040107640120
127
SANDRA ANARKI
PESERTA
07/01/1991
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
657
0001506211751 1901016820890002
127
YUNILA
ISTRI
28/02/1989
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
658
0001506211762 1901011506560001
129
KAHONO
PESERTA
15/06/1956
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
659
0001506211773 1901015112650001
129
ASMAWATI
ISTRI
12/11/1965
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
660
0001506211784 1901011210520006
131
TUKIMIN
PESERTA
12/10/1952
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
661
0001506211795 1901014509650002
131
SUTINI
ISTRI
05/09/1965
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
662
0001506211806 1901011212900005
131
HERIYANTO
ANAK
12/12/1990
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
663
0001506211817 1901014512990004
131
FEBI SINTA KRISTINA
ANAK
05/12/1999
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
12/2/15 3:15 PM
Page 29 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
664
0001506211828 1901012610550001
135
SUMARNI
PESERTA
26/10/1955
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
665
0001506211839 1901013112700005
136
MIKAN
PESERTA
31/12/1970
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
666
0001506211841 1901014806790002
136
KATMINI
ISTRI
08/06/1979
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
667
0001506211852 1901011406940001
136
AMAT AGUS SUPRIATNO
ANAK
14/08/1994
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
668
0001506211863 1901010609000003
136
EDI SETIAWAN
ANAK
11/05/2004
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
669
0001506211874 1901015105040002
136
VITRI MELIYANI LESTARI
ANAK
05/11/2004
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
670
0001879294601 1901016401140004
136
RIRIN CHANIA
ANAK
24/11/2004
KENANGA
01/09/2015
AKTIF
19,225
22/08/2015
671
0001506211885 1901012607810009
141
JAENURI
PESERTA
26/07/1981
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
672
0001506211896 1901014406840008
141
SRI LESTARI
ISTRI
04/06/1984
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
673
0001506211907 1901016305040007
141
MEI PUSPITA SARI
ANAK
23/05/2004
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
674
0001506211918 1901012408120002
141
FEBRIAN NURROHMAN
ANAK
24/08/2012
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
675
0001506211929 1901010311700002
145
SUTIONO
PESERTA
11/03/1970
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
676
0001506211931 1901016103890003
145
DINA SUSANTI
ISTRI
21/03/1989
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
677
0001506211942 1901016511050002
145
WAHYUNI
ANAK
25/11/2005
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
678
0001506211953 1901014803110001
145
NURCAHYATI
ANAK
08/03/2011
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
679
0001506211964 1901010203850003
149
RUDI IRAWAN
PESERTA
02/03/1985
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
680
0001506211975 1901016811930007
149
AMANATI SADIAH
ISTRI
28/11/1993
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
681
0001506211986 1901016309120004
149
ADELIA SYAHPUTRI
ANAK
23/09/2012
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
682
0001506211997 1901011105750003
152
RUKAN
PESERTA
11/05/1975
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
683
0001506212008 1901015203830004
152
MARTINI
ISTRI
12/03/1983
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
684
0001506212019 1901010901020001
152
KHOIRUL ANAM
ANAK
09/01/2002
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
685
0001506212021 1901012212060006
152
MUHAMMAD RIAN
ANAK
22/12/2006
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
686
0001506212032 1901016402110001
152
IRMA DWI MAULIDA
ANAK
24/02/2011
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
12/2/15 3:15 PM
Page 30 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
687
0001506212043 1901011407790002
157
HARYONO
PESERTA
14/07/1979
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
688
0001506212054 1901016102830001
157
KARTI
ISTRI
21/02/1983
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
689
0001506212065 1901010606040003
157
ERIC SETIAWAN
ANAK
06/06/2004
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
690
0001506212076 1901010505110002
157
KELVIN ARDIANSYAH
ANAK
05/05/2011
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
691
0001506212087 1901012412130003
157
IVAN DIMAS
ANAK
24/12/2013
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
692
0001506212098 1901011101920003
162
RUDI RUSLANI
PESERTA
11/01/1992
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
693
0001506212109 1901015208950010
162
TRI SUSANTI
ISTRI
12/08/1995
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
694
0001506212111 1901010505130004
162
REZI AL MIZAN RUSLANI
ANAK
05/05/2013
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
695
0001506212122 1901011503770003
165
FARIN
PESERTA
15/03/1977
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
696
0001506212133 1901016402790002
165
SUMIATI
ISTRI
24/02/1979
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
697
0001506212144 1901011704020004
165
AHMAT
ANAK
17/04/2002
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
698
0001506212155 1901011307040001
165
ARYA SAPUTRA
ANAK
13/07/2004
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
699
0001506212166 1901016307060001
165
NUR AMELIA PUTRI YULIANA
ANAK
23/07/2006
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
700
0001506212177 1901012702620001
170
JIN KON SOE
PESERTA
27/02/1962
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
701
0001506212188 1901015408670001
170
BONG KIM FUN
ISTRI
14/08/1967
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
702
0001506212199 1901012903970002
170
TERIO MULIADI
ANAK
29/03/1997
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
703
0001506212201 1901012009540001
173
BOEN HON TJOEN
PESERTA
20/09/1954
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
704
0001506212212 1901016907590001
173
TJHIN DJUN HO
ISTRI
29/07/1959
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
705
0001506212223 1901016712610002
175
NGIAT NON
PESERTA
27/12/1961
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
706
0001506212234 1901010702750001
176
BAHARUDIN
PESERTA
07/02/1975
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
707
0001506212245 1901015004900004
176
MARIANA
ISTRI
10/04/1990
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
708
0001506212256 1901015108110002
176
KESSYA RAHMAWATI
ANAK
11/06/2011
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
709
0001506212267 1802140603840001
179
MARSAM
PESERTA
26/08/1984
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
12/2/15 3:15 PM
Page 31 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
710
0001506212278 1901015010880011
179
ETI NOVA RAHAYU
ISTRI
10/10/1988
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
711
0001506212289 1901016710080003
179
DINDA OKTA FIANA
ANAK
27/10/2008
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
712
0001506212291 1901016503140005
179
DIANDRA MARSELLA
ANAK
25/03/2014
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
713
0001506212302 1901010905670003
183
SUKANTORO
PESERTA
09/05/1967
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
714
0001506212313 1901015612730001
183
DESILAWATI
ISTRI
16/12/1973
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
715
0001506212324 1901010603920006
183
RIANDI AGUNG PRATAMA
ANAK
06/03/1992
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
716
0001506212335 1901016106960005
183
JESSY SILVIANI
ANAK
21/06/1996
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
717
0001506212346 1901012302030002
183
MUHAMMAD IQBAL
ANAK
23/02/2003
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
718
0001506212357 1901016504730006
188
RUNI APSIAH
PESERTA
25/04/1973
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
719
0001506212368 1901011208000012
188
MUHAMMAD IKHSAN
ERLANGGA
ANAK
12/08/2000
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
720
0001506212379 1901014712940003
190
DERI HERAWATI
PESERTA
07/12/1994
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
721
0001506212381 1901011205730007
191
IWAN WIDARSA
PESERTA
12/05/1973
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
722
0001506212392 1901016908710002
191
AGUS YULIANAWATI
ISTRI
29/08/1972
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
723
0001506212403 1901010708960007
191
FEDRI MULANA
ANAK
07/08/1996
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
724
0001506212414 1901016605020004
191
INDRI PUTRIA
ANAK
16/05/2002
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
725
0001506212425 1901011504100003
195
GILANG PUTRA PRATAMA
PESERTA
15/04/2010
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
726
0001506212436 1901014707670007
196
TITIN SUHARTINI
PESERTA
07/07/1967
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
727
0001506212447 1901010307780003
197
UJANG MACHMUDIN
PESERTA
03/07/1978
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
728
0001506212458 1901015105810008
197
SANDRA DEWI
ISTRI
11/05/1981
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
729
0001506212469 1901010410060005
197
ANANDHA RONALDO
ANAK
04/10/2006
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
730
0001506212471 1901010407120001
197
ANANTHA INESTA
ANAK
04/07/2012
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
731
0001506212482 1901010307570008
201
RIDUAN OMO
PESERTA
03/07/1957
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
732
0001506212493 1901014508770003
201
LENY RUSWATY
ISTRI
05/08/1977
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
12/2/15 3:15 PM
Page 32 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
733
0001506212504 1901013108070004
201
ADITYA PRATAMA
ANAK
31/08/2007
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
734
0001506212515 1901010312000002
201
DODY PRANATA
ANAK
03/12/2010
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
735
0001506212526 1901011208800004
205
DEDI SETIA
PESERTA
08/12/1980
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
736
0001506212537 1901016406830003
205
SUWARNI ZHEASARI
ISTRI
14/06/1983
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
737
0001506212548 1901016407090001
205
OZHINDIONI
ANAK
24/07/2009
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
738
0001506212559 1901011412580002
208
SARIYAN
PESERTA
14/12/1958
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
739
0001506212561 1901014107600011
208
WAKIYAH
ISTRI
07/01/1960
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
740
0001506212572 1901011608540001
210
LO DJAN BOE
PESERTA
16/09/1954
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
741
0001506212583 1901010909420003
211
LAY KON HIOEN
PESERTA
09/09/1942
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
742
0001506212594 1971040210640000
212
ASMAT
PESERTA
02/10/1954
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
743
0001506212605 1971044702550003
212
SANAYAH
ISTRI
07/02/1955
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
744
0001506212616 1901014605500001
214
RUSNI
PESERTA
06/05/1950
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
745
0001506212627 1901016107930002
214
DEDE RABTIANI YULIANDRI
ANAK
21/07/1993
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
746
0001506212638 1901014909960003
214
TIA LESTARI DEWIYANTI
ANAK
09/09/1996
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
747
0001506212649 1901011309690003
217
IRWAN
PESERTA
13/09/1969
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
748
0001506212651 1901014710740001
217
ROSNI
ISTRI
07/10/1974
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
749
0001506212662 1901011404990005
217
DEO AFRIZALDO
ANAK
14/04/1999
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
750
0001506212673 1901011407060002
217
DZAKY DZULFATH RIZKY
ANAK
14/07/2006
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
751
0001506212684 1901012103130001
217
KENZIE AZKA ALKHALIFI
ANAK
21/03/2013
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
752
0001506212695 1901012005450001
222
JUMADI
PESERTA
20/05/1945
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
753
0001506212706 1901014710450001
222
ROBANI
ISTRI
07/10/1945
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
754
0001506212717 1905041406940004
222
PRANSETIA PRATAMA
ANAK
14/06/1994
KENANGA
01/09/2015
AKTIF
19,225
20/08/2015
755
0001506283931 1901044107490022
Suma'ah
PESERTA
01/07/1949
PETALING
01/10/2015
AKTIF
19,225
15/09/2015
12/2/15 3:15 PM
Page 33 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
756
0001506283942 1901055010880005
Sumira
PESERTA
10/10/1988
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
757
0001506283953 1901062802120003
Ahmad Rafi Dirgantara
ANAK
28/02/2012
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
758
0001506283964 1901055010110002
Alisa Nanda Arpida
ANAK
10/10/2014
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
759
0001886513859 1901066410500002
Amsiah
TAMBAHAN
24/10/1950
PEMALI
01/10/2015
AKTIF
19,225
16/09/2015
760
0001506283975 1901060212690002
Muhammad Saher
PESERTA
12/02/1969
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
761
0001506283986 1901051704070001
Muhammad Naufal
ANAK
17/04/2007
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
762
0001886515356 1901054107370009
SURIM
TAMBAHAN
02/05/1938
PEMALI
01/10/2015
AKTIF
19,225
16/09/2015
763
0001506283997 1901050102290001
H. Rakmin
PESERTA
02/01/1929
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
764
0001886525199 1901056210640002
Hj. Rosinah
ANAK
22/10/1964
PEMALI
01/10/2015
AKTIF
19,225
16/09/2015
765
0001886516133 1901051209040001
Perdana Mahesa
TAMBAHAN
13/09/2004
PEMALI
01/10/2015
AKTIF
19,225
16/09/2015
766
0001506284008 1901051007360001
Simi
PESERTA
07/10/1936
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
767
0001506284019 1901060312690001
Muhammad Adaid
PESERTA
12/03/1959
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
768
0001506284021 1901051511078661
Halimah
ISTRI
12/12/1959
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
769
0001506284032 1901051004820004
11
Sapawi
PESERTA
04/10/1982
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
770
0001506284043 1901054207120001
11
Zulfaa Syafia Husna
ANAK
07/03/2012
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
771
0001506284054 1901057012700002
13
Rina Sagita
PESERTA
30/12/1970
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
772
0001506284065 1901050410040001
13
Raki Oktapiandi
ANAK
10/04/2004
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
773
0001886525673 1901050202980001
13
Ronaldi
ANAK
02/02/1990
PEMALI
01/10/2015
AKTIF
19,225
16/09/2015
774
0001506284076 1901054401910002
15
Evi Lestari
PESERTA
01/04/1991
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
775
0001506284087 1901050107310005
16
H. Juhari
PESERTA
07/01/1931
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
776
0001506284098 1901052106530003
17
Kamhar
PESERTA
21/06/1953
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
777
0001506284109 1901954503590003
17
Suryama
SUAMI
03/05/1959
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
778
0001506284111 1901054110120002
19
Nezela Oktafiona
PESERTA
10/01/2012
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
12/2/15 3:15 PM
Page 34 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
779
0001506284122 1901050507450001
20
Hamzah
PESERTA
07/05/1945
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
780
0001506284133 1901055001490001
20
Paridah
ISTRI
01/10/1949
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
781
0001886526033 1901052408750001
20
Rano
ANAK
24/08/1975
PEMALI
01/10/2015
AKTIF
19,225
16/09/2015
782
0001886526178 1901052404780001
20
Muhammad Faslah
ANAK
24/04/1978
PEMALI
01/10/2015
AKTIF
19,225
16/09/2015
783
0001886526347 1901050411850001
20
Husni Mudorat
ANAK
11/04/1985
PEMALI
01/10/2015
AKTIF
19,225
16/09/2015
784
0001506284144 1901056808550001
22
Suhana
PESERTA
28/08/1955
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
785
0001506284155 1901054112510001
23
Hj. Cik Minah
PESERTA
12/01/1951
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
786
0001506284166 1901054107670023
24
Saripah
PESERTA
07/01/1967
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
787
0001506284177 1901062108910001
24
Sutrisman
ANAK
21/08/1991
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
788
0001886527563 1901056204890001
24
Susilawati
ANAK
22/04/1989
PEMALI
01/10/2015
AKTIF
19,225
16/09/2015
789
0001506284188 1901050107600015
26
Kudir
PESERTA
03/12/1960
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
790
0001506284199 1901054107670022
26
Mina
ISTRI
07/01/1967
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
791
0001506284201 1901062562930002
26
Ulenni
ANAK
25/12/1993
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
792
0001506284212 1901052012020001
26
Yugi
ANAK
20/12/2002
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
793
0001506284223 1901051312040002
26
Ulan
ANAK
25/07/2005
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
794
0001886528294 1901052512890001
26
Munggo
ANAK
25/12/1989
PEMALI
01/10/2015
AKTIF
19,225
16/09/2015
795
0001506284234 1901050511860006
31
Supardi. S
PESERTA
11/05/1986
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
796
0001506284245 1901055308850002
31
Sarvina
ISTRI
13/08/1985
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
797
0001506284256 1901055512050003
31
Elsa Natasia
ANAK
15/01/2005
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
798
0001506284267 1901056109130001
31
Dea Elmira
ANAK
21/09/2013
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
799
0001506284278 1901051205820003
35
Abdul Kadir
PESERTA
05/12/1982
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
800
0001506284289 1901055809820002
35
Tanti Rosi
ISTRI
18/09/1982
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
801
0001506284291 1901055607050001
35
Adelia Tifani
ANAK
16/07/2005
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
12/2/15 3:15 PM
Page 35 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
802
0001506284302 1901057007120001
35
Azkia Devina Ramadhani
ANAK
30/07/2012
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
803
0001506284313 1901050104530002
39
Sukardus
PESERTA
04/01/1953
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
804
0001506284324 1901055108540001
39
Sauni
ISTRI
08/11/1994
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
805
0001506284335 1901050207510001
41
Saili
PESERTA
07/02/1951
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
806
0001506284346 1901054408570001
41
Aini
ISTRI
08/04/1957
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
807
0001506284357 1901054107660009
43
Uji Burmin
PESERTA
07/01/1966
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
808
0001506284368 1901050810560002
44
Amrin Sanen
PESERTA
10/08/1958
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
809
0001506284379 1901054102520001
45
Ulya
PESERTA
02/01/1962
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
810
0001506284381 1901050808590003
46
Sailan Bakar
PESERTA
08/08/1959
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
811
0001506284392 1901054107650030
46
Musnah
ISTRI
07/01/1965
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
812
0001506284403 1901056008980003
46
Adetiya
ANAK
20/08/1998
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
813
0001506284414 1901050101820002
49
Subika
PESERTA
01/01/1982
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
814
0001506284425 1901051705030003
49
Hafid Hadinata
ANAK
17/05/2003
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
815
0001506284436 1901051304050002
49
Randika
ANAK
13/04/2005
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
816
0001506284447 1901051107110001
49
Dodi Sanjaya
ANAK
07/11/2011
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
817
0001506284458 1901050612760002
53
Rianto
PESERTA
12/06/1976
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
818
0001506284469 1901056206820010
53
Ratna
ISTRI
22/06/1982
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
819
0001506284471 1901050804100003
53
Muhammad Ramon Saputra
ANAK
04/08/2010
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
820
0001506284482 1901051109120004
53
Muhammad Amin Remos
ANAK
09/11/2012
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
821
0001506284493 1901062008600001
57
Syamsu
PESERTA
20/08/1960
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
822
0001506284504 1901056811670002
57
Haminah
ISTRI
28/11/1967
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
823
0001506284515 1901052601960001
57
Septa Saputra
ANAK
26/01/1996
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
824
0001506284526 1901064510000001
57
Selen Syaputri
ANAK
10/05/2000
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
12/2/15 3:15 PM
Page 36 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
825
0001506284537 1901052603610001
61
Wardi
PESERTA
26/03/1961
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
826
0001506284548 1901055505710001
61
Harleni
ISTRI
15/05/1971
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
827
0001506284559 1901052707050001
61
Pajar Ilham
ANAK
27/07/2005
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
828
0001506284561 1901051203610002
64
Jahidin
PESERTA
03/12/1961
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
829
0001506284572 1901060703880001
65
Arminggo
PESERTA
02/07/1988
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
830
0001506284583 1901055907920002
65
Juliawati
ISTRI
19/07/1992
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
831
0001506284594 1901052001080002
65
Julian Zufarel
ANAK
20/01/2008
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
832
0001506284605 1901052812130001
65
Dio Alfaro
ANAK
28/12/2013
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
833
0001506284616 1901051803630006
69
Hamzah
PESERTA
18/03/1963
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
834
0001506284627 1901054610660002
69
Jamiyah
ISTRI
10/06/1966
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
835
0001506284638 1901051212910004
69
Reki Syahputra
ANAK
12/12/1991
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
836
0001886529464 1901050901880002
69
Jumani
ANAK
01/09/1988
PEMALI
01/10/2015
AKTIF
19,225
16/09/2015
837
0001886520172 1901055907980001
69
Sanika Julianti
TAMBAHAN
19/07/1998
PEMALI
01/10/2015
AKTIF
19,225
16/09/2015
838
0001506284649 1901052407800002
72
Hairul
PESERTA
24/07/1980
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
839
0001506284651 1901056304830002
72
Aspita
ISTRI
23/04/1983
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
840
0001506284662 1901050509020002
72
Vikry Fahriyal Utama
ANAK
09/05/2002
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
841
0001506284673 1901052711070003
72
Dwi Fano Bandara
ANAK
27/11/2007
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
842
0001506284684 1901056403110002
72
Husna Zein Hafidzah
ANAK
24/03/2011
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
843
0001506284695 1901050811750001
77
Isron
PESERTA
11/08/1975
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
844
0001506284706 1901054505770002
77
Ernawati
ISTRI
05/05/1977
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
845
0001506284717 1901050104990001
77
Salamet Heryandi
ANAK
04/01/1999
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
846
0001506284728 1901054810080004
77
Naysilla Oktavia
ANAK
10/08/2008
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
847
0001506284739 1901050107130001
81
Bahtiar
PESERTA
08/05/1961
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
12/2/15 3:15 PM
Page 37 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
848
0001506284741 1901054508790004
81
Rastinah
ISTRI
08/05/1979
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
849
0001506284752 1901054206100002
81
Barinda
ANAK
06/02/2010
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
850
0001506284763 1901050107490010
84
Kurnan Bin Kabul
PESERTA
07/01/1949
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
851
0001506284774 1901055003530002
84
Hatimah
ISTRI
03/10/1953
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
852
0001506284785 1901054306920002
84
Utama Dewi Mayasari
ANAK
06/03/1992
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
853
0001506284796 1901050810970002
84
Dedi Kurniawan
ANAK
10/08/1997
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
854
0001886529756 1901054808800004
84
Fadila
ANAK
08/08/1980
PEMALI
01/10/2015
AKTIF
19,225
16/09/2015
855
0001886530037 1901050107820028
84
Faharuddin
ANAK
07/01/1982
PEMALI
01/10/2015
AKTIF
19,225
16/09/2015
856
0001506284807 1901055703730001
88
Aziza
PESERTA
17/03/1973
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
857
0001506284818 1901055802030005
88
Mirna
ANAK
18/02/2003
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
858
0001506284829 1901055504060003
88
Dara
ANAK
15/04/2006
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
859
0001506284831 1901041708150002
91
Suhardi
PESERTA
17/08/1975
PETALING
01/10/2015
AKTIF
19,225
15/09/2015
860
0001506284842 1901011411670007
92
Sopian
PESERTA
14/11/1967
SUNGAILIAT
01/10/2015
AKTIF
19,225
15/09/2015
861
0001506284853 1901015104790002
92
Siti Aminah
ISTRI
04/11/1979
SUNGAILIAT
01/10/2015
AKTIF
19,225
15/09/2015
862
0001506284864 1901010906010001
92
Rifqi Ikhsanda
ANAK
06/09/2001
SUNGAILIAT
01/10/2015
AKTIF
19,225
15/09/2015
863
0001506284875 1901011909070005
92
Arfyandika Ramadhan
ANAK
19/09/2007
SUNGAILIAT
01/10/2015
AKTIF
19,225
15/09/2015
864
0001506284886 1901012805120001
92
Aditya Rizki FahReza
ANAK
28/05/2012
SUNGAILIAT
01/10/2015
AKTIF
19,225
15/09/2015
865
0001506284897 1901010512680002
97
Waldini
PESERTA
15/12/1968
SUNGAILIAT
01/10/2015
AKTIF
19,225
15/09/2015
866
0001506284908 1901016908770003
97
Elvi Syahrita
ISTRI
29/08/1977
SUNGAILIAT
01/10/2015
AKTIF
19,225
15/09/2015
867
0001506284919 1901010312070002
97
Zathan Nuchoiril
ANAK
12/03/2007
SUNGAILIAT
01/10/2015
AKTIF
19,225
15/09/2015
868
0001506284921 1901060209740002
100
Sumardi
PESERTA
09/02/1974
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
869
0001506284932 1901055402750001
100
Anita
ISTRI
14/12/1974
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
870
0001506284943 1901051809030001
100
Gunadiantono
ANAK
18/09/2003
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
12/2/15 3:15 PM
Page 38 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
871
0001506284954 1901056809120002
100
Annisa Nurherawati
ANAK
28/09/2012
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
872
0001506284965 1901012303600004
104
Edy Narso Wiryas Husin
PESERTA
23/03/1960
SUNGAILIAT
01/10/2015
AKTIF
19,225
15/09/2015
873
0001506284976 1901014506570003
104
Maryani
ISTRI
06/05/1957
SUNGAILIAT
01/10/2015
AKTIF
19,225
15/09/2015
874
0001506284987 1901011011900001
104
Paul
ANAK
11/10/1990
SUNGAILIAT
01/10/2015
AKTIF
19,225
15/09/2015
875
0001506374109 1901012402740002
19
AHMAD. M
PESERTA
24/02/1974
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
876
0001506374548 1901015211790001
19
HASANAH
ISTRI
11/12/1979
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
877
0001506374177 1901011809130001
19
HIKMAL ARDIANSAH
ANAK
18/09/2013
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
878
0001506374188 1901010702030002
19
RISKY KURNIAWAN
ANAK
02/07/2003
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
879
0001506374199 1901016801010002
19
ELPINA ROSA
ANAK
28/01/2001
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
880
0001506374201 1901015108970003
19
APRI SINTA
ANAK
08/11/1997
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
881
0001895159744 1901011708880013
19
SUHARDIMAN
TAMBAHAN
17/08/1988
KENANGA
01/11/2015
AKTIF
19,225
16/10/2015
882
0001506374111 1901017112730002
16
ASMI
PESERTA
31/12/1973
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
883
0001506374526 1901015411010002
16
MIA SELMI
ANAK
14/11/2001
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
884
0001506374537 1901016404070003
16
SANTIA
ANAK
24/04/2007
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
885
0001506374122 1901012501550004
14
SAIDI
PESERTA
25/01/1955
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
886
0001506374515 1901015706580001
14
ASNAH
ISTRI
17/06/1958
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
887
0001506374133 1901015912520004
13
HASIAH
PESERTA
19/12/1952
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
888
0001506374144 1901010801680002
30
SAIDIN
PESERTA
01/03/1968
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
889
0001895161026 1901010101710011
30
ALMAN
TAMBAHAN
01/01/1971
KENANGA
01/11/2015
AKTIF
19,225
16/10/2015
890
0001506374155 1901012306820005
29
ROMADON
PESERTA
23/06/1982
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
891
0001506374166 1901011211790004
25
RONY
PESERTA
12/11/1979
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
892
0001506374559 1901015401840001
25
HASNI
ISTRI
14/01/1984
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
893
0001506374561 1901010502030004
25
HARIYANTO
ANAK
02/05/2003
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 39 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
894
0001506374572 1901016805050003
25
ROSAILA HANDAYANI
ANAK
28/05/2005
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
895
0001895160879 1901016611980001
25
SURYANI
TAMBAHAN
26/11/1998
KENANGA
01/11/2015
AKTIF
19,225
16/10/2015
896
0001506374212 1901010409620001
34
SUHARTO
PESERTA
09/04/1962
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
897
0001506374605 1901014307720002
34
ARA
ISTRI
07/03/1972
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
898
0001506374289 1901012705090002
34
ARIL MAULIDI
ANAK
27/05/2009
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
899
0001506374291 1901014801060001
34
SUHARTINI
ANAK
01/08/2006
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
900
0001506374616 1901010404900001
34
ARYONO
ANAK
04/04/1990
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
901
0001506374627 1901015505940004
34
SUKINAH
ANAK
15/05/1994
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
902
0001506374638 1901012911980001
34
ARFENDI
ANAK
29/11/1998
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
903
0001506374649 1901010606010004
34
ARMANGGA
ANAK
06/06/2001
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
904
0001506374651 1901015811030006
34
SUFITRAH
ANAK
18/11/2003
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
905
0001506374223 1901010610580003
31
SYAMSUDIN
PESERTA
10/06/1958
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
906
0001506374583 1901014612620003
31
SUMARNI
ISTRI
12/06/1962
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
907
0001506374594 1901010708890004
31
SULAROWISNU
ANAK
08/07/1989
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
908
0001895643685 1901010507860005
31
ACHIL
TAMBAHAN
05/07/1986
KENANGA
01/11/2015
AKTIF
19,225
19/10/2015
909
0001506374234 1901012308850004
49
ROJIAH
PESERTA
07/06/1968
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
910
0001506374335 1901011709940002
49
RODAYAT
ANAK
17/09/1994
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
911
0001506374684 1901014710670004
49
SERITA
ANAK
10/07/1967
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
912
0001506374245 1901012303470001
48
MARDI
PESERTA
23/03/1947
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
913
0001506374256 1901014405580005
47
JAS'AH
PESERTA
05/04/1958
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
914
0001506374267 1901015501560001
45
NURLINA
PESERTA
15/01/1956
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
915
0001506374673 1901014111790001
45
FAHMI
ANAK
11/01/1979
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
916
0001506374278 1901010308630002
43
ASRU B. KAIT
PESERTA
03/08/1963
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 40 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
917
0001506374662 1901014202630003
43
MIDAN
ISTRI
02/02/1963
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
918
0001506374302 1901010803670001
56
SARMINO
PESERTA
03/08/1967
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
919
0001506374717 1901015111730005
56
SALBIAH
ISTRI
11/11/1973
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
920
0001506374728 1901011303910002
56
SANDI
ANAK
13/03/1991
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
921
0001506374739 1901012704930005
56
SANDRA
ANAK
27/04/1993
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
922
0001506374741 1901010704030013
56
SYALU
ANAK
04/07/2003
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
923
0001506374313 1901010802560001
53
ASKAR KAIT
PESERTA
02/08/1956
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
924
0001506374695 1901015208560001
53
ROHANI
ISTRI
08/12/1956
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
925
0001506374706 1901010107950008
53
ARDIANSAH
ANAK
07/01/1995
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
926
0001506374324 1901012606660001
52
KASIM
PESERTA
26/06/1966
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
927
0001506374346 1901016204800001
69
AJAW
PESERTA
22/04/1980
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
928
0001506374796 1901010204030003
69
ANDRE YULIANTO
ANAK
03/02/2003
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
929
0001506374807 1901010503130007
69
AHMAD PRATAMA
ANAK
03/05/2013
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
930
0001506374357 1901010107830008
68
RAYIT
PESERTA
07/01/1983
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
931
0001506374368 1901010212680001
65
DJUNAIDI
PESERTA
12/02/1966
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
932
0001506374774 1901014107700006
65
NORMAH
ISTRI
07/01/1970
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
933
0001506374785 1901014702960001
65
SUCI RUKMANA
ANAK
12/07/1996
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
934
0001506374379 1901014406350001
64
RAHIMA
PESERTA
06/04/1935
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
935
0001506374381 1901016510750004
61
SUKARTI
PESERTA
25/10/1975
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
936
0001506374752 1901016404950003
61
MIRNA DESTIANTIKA
ANAK
24/04/1995
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
937
0001506374763 1901016305010003
61
MEGA SILVIA
ANAK
23/05/2001
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
938
0001506374392 1901011803700006
NGUI MUK BU
PESERTA
18/03/1970
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
939
0001506374403 1901016009730005
KIM YUN
ISTRI
20/09/1973
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 41 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
940
0001506374414 1901012103000002
RUDY FEDRIYANTO
ANAK
21/03/2000
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
941
0001506374425 1901017003020004
GITA PURWASI PUTRI
ANAK
30/03/2002
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
942
0001895158798 1901016712370002
THONG A NYUK
TAMBAHAN
27/12/1937
KENANGA
01/11/2015
AKTIF
19,225
16/10/2015
943
0001506374436 1901015907830007
FIFI
PESERTA
19/07/1983
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
944
0001506374447 1901014905740003
ALIES
PESERTA
05/07/1974
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
945
0001506374458 1901012107450001
MAIMUNAH
PESERTA
21/07/1945
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
946
0001506374469 1901010109490007
CEPEH
PESERTA
09/01/1949
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
947
0001506374471 1901016709620001
KALOK
ISTRI
27/09/1962
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
948
0001506374482 1901012212660002
10
YANTO
PESERTA
22/12/1966
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
949
0001506374493 1901015901700005
10
SAMIDAH
ISTRI
19/01/1970
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
950
0001506374504 1901012112040005
10
HAISAL
ANAK
21/12/2004
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
951
0001506374818 1901014807020001
72
DEWI YULIANI
PESERTA
07/08/2002
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
952
0001506374829 1901010109570002
73
BIBIT SARJU
PESERTA
09/01/1957
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
953
0001506374831 1901016512830015
73
FITA ROHAYATI
ISTRI
25/12/1983
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
954
0001506374842 1901014110040007
73
LITA ANGGIANI
ANAK
10/01/2004
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
955
0001506374853 1901014402090003
73
NURUL HOLIFAH
ANAK
02/04/2009
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
956
0001506374864 1901015401130001
73
JAHRA BUNGA SAFITRI
ANAK
14/01/2013
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
957
0001506374875 1901015005780006
78
ITA
PESERTA
05/10/1978
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
958
0001506374886 1901017101010001
78
RANI ARDIYANTI
ANAK
31/01/2001
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
959
0001506374897 1901014308040003
78
AGUSTALIA
ANAK
08/03/2004
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
960
0001506374908 1901011906590004
81
USMAN
PESERTA
19/06/1959
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
961
0001506374919 1901016812630005
81
HINDUN
ISTRI
28/12/1963
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
962
0001506374921 1901012102910001
83
JUBRIANSYAH
PESERTA
21/02/1991
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 42 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
963
0001506374932 1901016701950004
83
MARINA
ISTRI
27/01/1995
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
964
0001506374943 1901012303110003
83
RIZKY ADITYA
ANAK
23/03/2011
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
965
0001506374954 1901011107720001
86
ALIYAS
PESERTA
07/11/1972
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
966
0001506374965 1901016611730007
86
ALOS
ISTRI
26/11/1973
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
967
0001506374976 1901011807600001
88
TARMIZI
PESERTA
18/07/1960
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
968
0001506374987 1901015909680002
88
ROSNAH
ISTRI
19/09/1968
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
969
0001506374998 1901015503060004
88
REVINA
ANAK
15/03/2006
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
970
0001506375009 1901011711810003
91
BASTOMI
PESERTA
17/11/1981
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
971
0001506375011 1901014101850010
91
SAMSIAH
ISTRI
01/01/1985
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
972
0001506375022 1901016709050002
91
SARDIANSYAH SAPUTRA
ANAK
27/09/2005
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
973
0001506375033 1901012107110001
91
HARIRI AZIS
ANAK
21/07/2011
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
974
0001506375044 1901014805500003
95
SUMSU
PESERTA
05/08/1950
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
975
0001506375055 1901016809650001
96
AINUN
PESERTA
28/09/1965
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
976
0001506375066 1901012312460001
97
RUSLI
PESERTA
23/12/1946
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
977
0001506375077 1901016601550001
97
ROBUNA PUTIK
ISTRI
26/01/1955
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
978
0001506375088 1901010101920004
97
RENDIANSYAH
ANAK
01/01/1992
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
979
0001506375099 1901012511880005
100
JUANDI
PESERTA
25/11/1988
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
980
0001506375101 1901011711100002
100
FADJERI YANSYAH
ANAK
17/11/2010
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
981
0001506375112 1901012512130002
100
MUHAMMAD NAZRIL ILHAM
ANAK
25/12/2013
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
982
0001506375123 1901010808770001
103
SUDIARTA
PESERTA
08/08/1977
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
983
0001506375134 1901016508810001
103
BAIMUN
ISTRI
25/08/1981
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
984
0001506375145 1901016306030001
103
FEBYANTI
ANAK
23/06/2003
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
985
0001506375156 1901011811720001
106
MOH. RIZAL
PESERTA
18/11/1972
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 43 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
986
0001506375167 1901014808720001
106
ROSIDAH
ISTRI
08/08/1972
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
987
0001506375178 1901015702980002
106
FEBRI AGUSTIN
ANAK
17/02/1998
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
988
0001506375189 1901011509080004
106
RORI PRATAMA
ANAK
15/09/2005
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
989
0001506375191 1901010601520002
110
ARBAN
PESERTA
01/06/1952
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
990
0001506375202 1901014707550002
110
NONI
ISTRI
07/07/1955
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
991
0001506375213 1901014606860003
110
RINA
ANAK
06/06/1986
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
992
0001506375224 1901012712700004
113
AMRON
PESERTA
27/12/1970
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
993
0001506375235 1901017006650007
113
ASIAH
ISTRI
30/06/1965
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
994
0001506375246 1901014707000003
113
YULIA
ANAK
07/07/2000
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
995
0001506375257 1901010305550001
116
SAMATUNAL BAMBANG
PESERTA
05/03/1955
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
996
0001506375268 1901015212020003
116
SULISYANI RAHAYU
SETIAWAN NINGSIH
ANAK
12/12/2002
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
997
0001506375279 1901012504700007
118
ROZALI
PESERTA
25/04/1970
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
998
0001506375281 1901015304800007
118
AMNAH
ISTRI
13/04/1980
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
999
0001506375292 1901012202000003
118
HUDYSAH
ANAK
22/02/2000
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,000 0001506375303 1901011707030003
118
ACHMAD FADJRI
ANAK
17/07/2003
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,001 0001506375314 1901012011090002
118
RAFA NOVRIANSYAH
ANAK
20/11/2009
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,002 0001506375325 1901010310700002
123
MIRADA
PESERTA
03/10/1970
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,003 0001506375336 1901016303740002
123
HERLINA
ISTRI
23/03/1974
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,004 0001506375347 1901015002010003
123
MITANA DILA
ANAK
02/10/2001
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,005 0001506375358 1901010305070002
123
DAUZAN HAKIM
ANAK
05/03/2007
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,006 0001506375369 1901010108500001
127
SIDIK
PESERTA
08/01/1950
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,007 0001506375371 1901015206520001
127
YUNI
ISTRI
06/12/1952
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,008 0001506375382 1901012001930001
127
MOH. ALI
ANAK
20/01/1993
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 44 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,009 0001506375393 1901015609600005
130
ROSNAH
PESERTA
16/09/1960
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,010 0001506375404 1901010107630011
131
SARMADA
PESERTA
07/01/1963
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,011 0001506375415 1901016607680001
131
NURAIDA
ISTRI
26/07/1968
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,012 0001506375426 1901011310020005
131
ABDULLAH
ANAK
13/10/2002
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,013 0001506375437 1901012410790002
134
HODRI
PESERTA
24/10/1979
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,014 0001506375448 1901014710800009
134
SARNI
ISTRI
10/07/1980
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,015 0001506375459 1901015907990003
134
HANISA HUSNAH
ANAK
19/07/1999
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,016 0001506375461 1901016911050003
134
KHOLQIYYATUN HASANAH
ANAK
29/11/2005
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,017 0001506375472 1901010907110005
134
AHMAD FATIHUDDIN
ANAK
07/09/2011
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,018 0001506375483 1901011403860003
139
TONI
PESERTA
14/03/1986
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,019 0001506375494 1901014601870003
139
LISA
ISTRI
01/06/1987
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,020 0001506375505 1901015307050003
139
TOYBAH
ANAK
13/07/2005
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,021 0001506375516 1901017105090003
139
TIARAWATI
ANAK
31/05/2009
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,022 0001506375527 1901012503480001
143
ROZALI
PESERTA
25/03/1948
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,023 0001506375538 1901014405490001
143
ROSMI
ISTRI
05/04/1949
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,024 0001506375549 1901012308780003
143
M. SYARAPI
ANAK
23/07/1976
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,025 0001506375551 1901010808700009
146
SAMSUL BAHRI
PESERTA
06/08/1970
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,026 0001506375562 1901015810730003
146
BAITI
ISTRI
18/10/1973
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,027 0001506375573 1901010508920006
146
EKI
ANAK
08/05/1992
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,028 0001506375584 1901013107950002
146
JENESA PRADELA
ANAK
31/07/1995
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,029 0001506375595 1901013108040002
146
ANGGI SILYADI
ANAK
31/08/2004
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,030 0001506375606 1901012107690001
151
SULKAN
PESERTA
21/07/1969
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,031 0001506375617 1901015708700005
151
GUSTIASURI
ISTRI
17/08/1970
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 45 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,032 0001506375628 1901016707940006
151
SUSILAWATI
ANAK
27/07/1994
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,033 0001506375639 1901012011000005
151
NAWAN
ANAK
20/11/2000
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,034 0001506375641 1901010909600002
155
TAUFIK
PESERTA
09/09/1960
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,035 0001506375652 1901012701620001
156
KOSIM
PESERTA
27/01/1962
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,036 0001506375663 1901014102680006
156
TOHIDA RUSNAH
ISTRI
02/01/1968
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,037 0001506375674 1901013005910004
156
DIDI PRAMANA
ANAK
30/05/1991
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,038 0001506375685 1901012401970001
156
ADI SAPUTRTA
ANAK
24/01/1997
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,039 0001506375696 1901011808030001
156
ZIKRI PRADANA
ANAK
18/08/2003
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,040 0001506375707 1901010109680002
161
SARDADI
PESERTA
09/01/1968
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,041 0001506375718 1901015909680003
161
ASNAH
ISTRI
19/09/1968
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,042 0001506375729 1901014711970001
161
SUMIYATI
ANAK
11/07/1997
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,043 0001506375731 1901014506010006
161
ERMAWATI
ANAK
06/05/2001
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,044 0001506375742 1901015701100002
161
MEGA MUSTIKA
ANAK
17/01/2010
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,045 0001506375753 1901015000600003
166
RENITA EXADINATA
PESERTA
09/10/2006
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,046 0001506375764 1901014107890009
167
SUSANTI
PESERTA
07/01/1989
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,047 0001895645081 1901015908930001
167
SUSINTA
TAMBAHAN
19/08/1993
KENANGA
01/11/2015
AKTIF
19,225
19/10/2015
1,048 0001506375775 1901012010600009
168
SEMA'AN
PESERTA
20/10/1960
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,049 0001506375786 1901015906660003
168
ICAH
ISTRI
19/06/1966
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,050 0001506375797 1901011908990005
168
SUWANTO
ANAK
20/06/1987
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,051 0001506375808 1901015001830012
171
MUSLIANA
PESERTA
01/10/1983
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,052 0001506375819 1901016705020001
171
JAURANI
ANAK
27/05/2002
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,053 0001506375821 1901014603130001
171
JOVITA MANDA
ANAK
03/06/2013
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,054 0001506375832 1901011911530001
174
SATAH
PESERTA
19/11/1953
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 46 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,055 0001506375843 1901014304560005
174
SONI
ISTRI
04/03/1956
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,056 0001506375854 1901014312910002
174
SUNARSIH
ANAK
12/03/1991
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,057 0001506375865 1901014301950002
174
SATIWA
ANAK
01/03/1995
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,058 0001506375876 1901010107010010
174
HIDAYAT
ANAK
07/01/2001
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,059 0001506375887 1901011812440001
179
ZULFAKAR
PESERTA
18/11/1944
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,060 0001506375898 1901014611510001
179
JUMANI
ISTRI
11/06/1955
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,061 0001506375909 1901010301920002
181
AHMAD DAMAI
PESERTA
01/03/1992
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,062 0001506375911 1901013004710001
182
HASANUSI
PESERTA
30/04/1971
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,063 0001506375922 1901011503710001
183
SUHARDI
PESERTA
15/03/1971
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,064 0001506375933 1901016703760001
183
SRI SUNARYATI
ISTRI
27/03/1976
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,065 0001506375944 1901010109930002
183
SURYANDI
ANAK
09/01/1993
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,066 0001506375955 1901010803030002
183
SUNARIO
ANAK
03/08/2003
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,067 0001506375966 1901010103790001
187
SURYANTO
PESERTA
03/01/1979
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,068 0001506375977 1901016304790003
187
DIANA
ISTRI
23/04/1979
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,069 0001506375988 1901011007110001
187
FADHILLAH IMAN PRATAMA
ANAK
07/10/2011
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,070 0001506375999 1901010704830001
190
SAHRIL
PESERTA
04/07/1983
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,071 0001506376001 1901014107860008
190
SAHARA
ISTRI
07/01/1986
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,072 0001506376012 1901012101080003
190
JULITASARI
ANAK
21/01/2008
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,073 0001506376023 1901011602130002
190
FEBRIANSYAH
ANAK
16/02/2013
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,074 0001506376034 1901011203520001
194
SADI BIN RESAT
PESERTA
12/03/1952
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,075 0001506376045 1901015811630002
194
SAMUNI
ISTRI
18/11/1963
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,076 0001506376056 1901014304650003
196
BAITUN
PESERTA
04/03/1965
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,077 0001506376067 1901015509980011
196
KARTIKA
ANAK
15/09/1998
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 47 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,078 0001506376078 1901015509980012
196
KARTINI
ANAK
15/09/1998
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,079 0001506376089 1901010612400002
199
SUPRI
PESERTA
12/06/1940
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,080 0001506376091 1901016606580006
200
NURHAYATI
PESERTA
26/06/1958
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,081 0001506376102 1901011606680001
201
SUHAIDI
PESERTA
16/06/1968
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,082 0001506376113 1901014305990007
201
SUKMAWATI
ISTRI
03/05/1999
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,083 0001506376124 1901012501030005
201
KHORY SAPUTRA
ANAK
25/01/2003
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,084 0001506376135 1901010210830001
204
SARBINI
PESERTA
10/02/1983
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,085 0001506376146 1901016107840001
204
NURMALA
ISTRI
21/07/1984
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,086 0001506376157 1901011011040001
204
MANSUR
ANAK
11/10/2004
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,087 0001506376168 1901011704650004
207
SULAIMAN
PESERTA
17/04/1966
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,088 0001506376179 1901015412730001
207
ROKIBA
ISTRI
14/12/1973
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,089 0001506376181 1901015907950001
207
POPPY SULISTYA
ANAK
19/07/1995
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,090 0001506376192 1901011502980002
207
ZELVI ADITYA
ANAK
15/02/1998
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,091 0001506376203 1901011910800004
211
DJAIBANI
PESERTA
19/10/1980
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,092 0001506376214 1901014702850002
211
AMINAH
ISTRI
02/07/1985
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,093 0001506376225 1901015707040005
211
DJULIANTI
ANAK
17/07/2004
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,094 0001506376236 1901016108090003
211
ASNI
ANAK
21/06/2009
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,095 0001506376247 1901010701130003
211
AJI MUHAMAD AKBAR
ANAK
01/07/2013
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,096 0001506376258 1901011707740001
216
HOLIDI
PESERTA
17/07/1974
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,097 0001506376269 1901014502800002
216
ARINA
ISTRI
02/05/1980
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,098 0001506376271 1901015508980004
216
ALISA
ANAK
15/08/1996
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,099 0001506376282 1901016207030003
216
ARIYANDA
ANAK
22/07/2003
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,100 0001506376293 1901010307100003
216
AZRIL
ANAK
07/03/2010
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 48 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,101 0001506376304 1901011011810005
221
ADI
PESERTA
11/10/1981
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,102 0001506376315 1901016808780001
221
IMI
ISTRI
28/08/1978
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,103 0001506376326 1901011307000002
221
ARMIZI
ANAK
13/07/2000
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,104 0001506376337 1901015305060002
221
MIDIAH
ANAK
13/05/2006
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,105 0001506376348 1901010809630004
225
ISNIN
PESERTA
09/09/1983
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,106 0001506376359 1901014107710027
225
FATIMAH
ISTRI
07/01/1971
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,107 0001506376361 1901010509920004
225
FIKRI
ANAK
09/05/1992
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,108 0001506376372 1901011511980003
225
RIZKI
ANAK
15/11/1998
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,109 0001506376383 1901011502940003
229
ALAN FEBRI
PESERTA
15/02/1994
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,110 0001506376394 1901015011960007
229
LENI NOVIYANTI
ISTRI
10/11/1996
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,111 0001506376405 1901015009130002
229
ALENA SEPTIANI
ANAK
10/08/2013
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,112 0001506376416 1901010906880006
232
INAN
PESERTA
09/06/1988
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,113 0001506376427 1901046503890004
232
SUSILA YANI
ISTRI
25/03/1989
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,114 0001506376438 1901012903140003
232
BAGAS PUTRA PRATAMA
ANAK
29/03/2014
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,115 0001506376449 1901011111690004
235
IMAM MUTHOHIR
PESERTA
11/11/1989
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,116 0001506376451 1901014206710003
235
IMAH. S.Ag
ISTRI
02/06/1971
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,117 0001506376462 1901014410950001
235
USWATUN KHASANAH
ANAK
04/10/1995
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,118 0001506376473 1901012010990002
235
ABDUL ROHMAN
ANAK
20/10/1999
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,119 0001506376484 1901011011080004
235
MOHD. NUR SALIM
ANAK
10/11/2008
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,120 0001506376495 1901081512720001
240
HERMANTO
PESERTA
15/12/1972
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,121 0001506376506 1901086702820003
240
DALILAH
ISTRI
27/02/1982
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,122 0001506376517 1901085308100002
240
DHIMA RAHMADANI
ANAK
13/08/2010
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,123 0001506376528 1901082503490001
243
ABDUL KODIR
PESERTA
25/03/1949
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 49 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,124 0001506376539 1901085005560001
243
SAMSIDAR
ISTRI
10/05/1956
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,125 0001506376541 1901084108780001
243
AGUSTINI
ANAK
01/08/1978
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,126 0001506376552 1901084602840001
243
CIK AYU
ANAK
06/02/1984
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,127 0001506376563 1901081302920001
243
ABDUL SOBRI
ANAK
13/02/1992
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,128 0001506376574 1901083112845001
248
SAMSUL
PESERTA
31/12/1984
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,129 0001506376585 1901084512890002
248
MASUDA
ISTRI
05/12/1989
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,130 0001506376596 1901080510080002
248
OKTA PUTRA
ANAK
05/10/2008
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,131 0001506376607 1901080501760001
251
SUDIRMAN
PESERTA
05/01/1976
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,132 0001506376618 1901086003780001
251
JAINUN
ISTRI
20/03/1978
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,133 0001506376629 1901087004990001
251
RIKA RISKI
ANAK
30/04/1999
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,134 0001506376631 1901083006030002
251
MUHAMMAD RISKI
ANAK
30/06/2003
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,135 0001506376642 1901080804080001
251
ANWAR GANI
ANAK
08/04/2008
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,136 0001506376653 1901081511130001
251
MUHAMMAD DALAN AANZARI
ANAK
15/11/2013
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,137 0001506376664 1901081906690001
257
MANI'I
PESERTA
19/06/1969
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,138 0001506376675 1901082911870002
257
HASBULLAH
ANAK
29/11/1987
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,139 0001506376686 1901082205930003
257
MUHAMMAD EDI
ANAK
22/05/1993
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,140 0001506376697 1901086311960001
257
PITRIYANTI
ANAK
22/01/1996
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,141 0001506376708 1901086806990001
257
CIAMIS
ANAK
28/06/1999
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,142 0001506376719 1901081007840001
262
JONI ARIANTO
PESERTA
10/07/1986
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,143 0001506376721 1901085312860003
262
SUKAWATI
ISTRI
13/12/1986
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,144 0001506376732 1901083003110001
262
JEPRI APRIANTA
ANAK
30/03/2011
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,145 0001506376743 1901086810130001
262
WIDIA
ANAK
28/10/2013
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,146 0001895646699 1901083003080002
262
MUHAMMAD SARBIAN
TAMBAHAN
30/03/2006
PUDING BESAR
01/11/2015
AKTIF
19,225
19/10/2015
12/2/15 3:15 PM
Page 50 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,147 0001506376754 1904060307870001
266
SUPRIYADI
PESERTA
03/07/1987
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,148 0001506376765 1904065002920003
266
DEWI MARIA ASTUTI
ISTRI
10/02/1992
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,149 0001506376776 1904064503110001
266
MARDELIMAWATI
ANAK
05/03/2011
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,150 0001506376787 1901061804880001
269
PUTRA
PESERTA
18/04/1988
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,151 0001506376798 1901086807870001
269
PAUZIAH
ISTRI
18/07/1987
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,152 0001506376809 1901085912130001
269
ALISYA FAIZAH
ANAK
19/12/2013
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,153 0001506376811 1904020107870028
272
ARYANTO
PESERTA
01/07/1987
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,154 0001506376822 1904025906860002
272
AZIZAH
ISTRI
19/06/1986
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,155 0001506376833 1904024301120001
272
AMINAT UZZUHRIAH
ANAK
03/01/2012
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,156 0001506376844 1901042603810001
275
HENDRI
PESERTA
26/05/1981
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,157 0001506376855 1901087009920005
275
MAULIDAYATI
ISTRI
30/09/1992
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,158 0001506376866 1901042906120003
275
M. ABDUL GHONI
ANAK
29/06/2012
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,159 0001506376877 1901084701730023
278
MARYANI
PESERTA
16/04/1975
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,160 0001506376888 1901085012880002
279
ABDULLAH PINAL
PESERTA
10/12/1988
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,161 0001506376899 1901085606930001
279
ELISA
ISTRI
16/06/1993
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,162 0001506376901 1901082712110001
279
MUHAMAD FAHRI
ANAK
27/12/2011
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,163 0001506376912 1901080302650001
282
ISHAK
PESERTA
03/02/1965
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,164 0001506376923 1901085609710001
282
ROSIAH
ISTRI
15/09/1971
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,165 0001506376934 1901080202000001
282
ROSADI
ANAK
02/02/2000
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,166 0001506376945 1901084807040001
282
SITI ROSIDAH
ANAK
06/07/2004
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,167 0001506376956 1901080209090001
282
MUHAMAD RAMADANI
ANAK
02/09/2009
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,168 0001506376967 1901080207900002
287
RIPANDI
PESERTA
02/07/1990
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,169 0001506376978 1901085211930004
287
RUSITA DEWI
ISTRI
22/11/1993
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 51 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,170 0001506376989 1901084106130001
287
RINDU SANDINA
ANAK
01/06/2013
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,171 0001506376991 1901082808840001
290
RIHOM
PESERTA
28/04/1984
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,172 0001506377002 1901086012860001
290
SITI MAISAROH
ISTRI
20/12/1986
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,173 0001506377013 1901080904070003
290
APRIYADI
ANAK
09/04/2007
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,174 0001506377024 1901086005110003
290
MELISA
ANAK
20/05/2011
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,175 0001506377035 1901083112760001
294
USMAN
PESERTA
31/12/1976
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,176 0001506377046 1901084701800005
294
PATRIAWATI
ISTRI
07/01/1980
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,177 0001506377057 1901085012020001
294
AYU SORAYA
ANAK
20/12/2002
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,178 0001506377068 1901084301080002
294
CAHYA ANJANI
ANAK
03/01/2008
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,179 0001506377079 1901082607130001
294
RAFA PRATAMA
ANAK
26/07/2013
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,180 0001506377081 1901080102800002
299
HERLI
PESERTA
01/02/1980
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,181 0001506377092 1901084701810009
299
YANTI
ISTRI
07/01/1981
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,182 0001506377103 1901086806010001
299
NONGITA
ANAK
28/06/2001
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,183 0001506377114 1901081901070001
299
SIJERI
ANAK
19/01/2007
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,184 0001506377125 1901085401160001
299
JELITA
ANAK
24/01/2015
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,185 0001506377136 1901082404700001
304
M. FUAD
PESERTA
24/04/1970
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,186 0001506377147 1901084701730014
304
ROMA
ISTRI
07/01/1973
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,187 0001506377158 1901080907960001
304
AHMAD ZUHRI
ANAK
09/07/1996
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,188 0001506377169 1901080907980001
304
AHMAD RANDI
ANAK
09/07/1998
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,189 0001506377171 1901084101010004
304
RASTI IROSPITA
ANAK
01/01/2001
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,190 0001506377182 1901080109820001
309
HERI
PESERTA
01/09/1982
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,191 0001506377193 1901086208870002
309
MULYATI
ISTRI
22/08/1987
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,192 0001506377204 1901081701060001
309
GERY FERGIAN
ANAK
17/01/2006
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 52 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,193 0001506377215 1901080206120001
309
EGI HERDINAN
ANAK
02/07/2012
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,194 0001506377226 1901081601820001
313
JONI
PESERTA
16/01/1982
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,195 0001506377237 1901086801840001
313
PATMAWATI
ISTRI
28/01/1984
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,196 0001506377248 1901084611040001
313
PUTRI NURMALA
ANAK
06/11/2004
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,197 0001506377259 1901080701630004
316
ASRI MUSA
PESERTA
07/01/1960
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,198 0001506377261 1901084701680011
316
MASWANI
ISTRI
07/01/1968
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,199 0001506377272 1901082404880004
316
MULYADI
ANAK
24/04/1988
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,200 0001506377283 1901085304010003
316
GITA SAPUTRI
ANAK
13/04/2001
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,201 0001506377294 1901080701800026
320
SANDRA
PESERTA
07/01/1980
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,202 0001506377305 1901084701850005
320
MARYANI
ISTRI
07/01/1985
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,203 0001506377316 1901084703020001
320
LENA
ANAK
07/03/2002
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,204 0001506377327 1901082909140002
323
MUHAMMAD HUSEIN
PESERTA
29/09/2014
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,205 0001506377338 1901080709810003
324
BURHANUDIN
PESERTA
07/09/1981
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,206 0001506377349 1901084710880003
324
RITA
ISTRI
07/10/1988
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,207 0001506377351 1901085707080001
324
ANGGUN CITRA PUSPITA
ANAK
17/07/2008
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,208 0001506377362 1901085802150001
324
NOFILA
ANAK
28/02/2015
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,209 0001506377373 1901080701830007
328
SANDRIK
PESERTA
07/01/1983
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,210 0001506377384 1901056609930003
328
SISKA
ISTRI
14/11/1993
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,211 0001506377395 1901086203120001
328
DEALOVA
ANAK
22/03/2012
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,212 0001506377406 1901080608120001
331
RAMDAN
PESERTA
06/08/2012
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,213 0001506377417 1901083110620001
332
YAZID
PESERTA
31/10/1962
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,214 0001506377428 1901081510880001
332
HERMAN SAWIRAN
ANAK
15/10/1988
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,215 0001506377439 1901084403900004
332
SURYAWATI
ANAK
04/03/1990
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 53 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,216 0001506377441 1901085510970002
332
MARIAH
ANAK
15/10/1997
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,217 0001506377452 1901085503020002
332
MARIANA
ANAK
15/03/2002
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,218 0001506377463 1901086710060002
332
YUNISA
ANAK
27/10/2006
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,219 0001895650514 1901084701300002
332
MASNAH
TAMBAHAN
07/01/1930
PUDING BESAR
01/11/2015
AKTIF
19,225
19/10/2015
1,220 0001506377474 1901080701810014
338
SOPIAN HADI
PESERTA
07/01/1981
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,221 0001506377485 1901086207840002
338
YULIAH
ISTRI
22/07/1984
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,222 0001506377496 1901082002060002
338
MUHAMMAD NAZAR PUTRA

JAYA
ANAK
20/02/2006
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,223 0001506377507 1901085306140001
338
PANIA INDRIANI
ANAK
13/05/2014
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,224 0001506377518 1904020404720001
342
AJIS
PESERTA
04/04/1972
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,225 0001506377529 1901086311760001
342
TINAH
ISTRI
28/06/1975
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,226 0001506377531 1901080311140001
342
AMANDA PUTRA ODE
ANAK
03/11/2014
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,227 0001506377542 1901082206880002
345
DEDI ARIYANTO
PESERTA
22/06/1988
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,228 0001506377553 1901086307900001
345
NURHALIMAH
ISTRI
23/07/1990
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,229 0001506377564 1901082509110001
345
AHMAD DAFA
ANAK
25/09/2011
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,230 0001506377575 1901081604770002
348
ALPAN
PESERTA
15/09/1970
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,231 0001506377586 1901085405750001
348
SITI AMINAH
ISTRI
08/05/1975
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,232 0001506377597 1901082203970003
348
ADAM
ANAK
22/03/1997
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,233 0001506377608 1901082308980002
348
MUHAMMAD
ANAK
23/08/1998
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,234 0001506377619 1901087005000002
348
LENA
ANAK
30/05/2000
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,235 0001506377621 1901083110110001
348
ZAINAL
ANAK
31/10/2011
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,236 0001506377632 1901081612900001
354
ZARKASI
PESERTA
16/11/1989
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,237 0001506377643 1901085406930001
354
JUMITA
ISTRI
14/06/1993
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,238 0001506377654 1901080112120001
354
IRSYAD
ANAK
01/12/2012
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 54 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,239 0001506377665 1901083112700001
357
HASIM
PESERTA
31/12/1970
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,240 0001506377676 1901086407740001
357
KUSUMAWATI
ISTRI
24/07/1974
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,241 0001506377687 1901086508970009
357
SOLLIHA
ANAK
25/08/1997
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,242 0001506377698 1901085403990001
357
SITI HATINAH
ANAK
14/03/1999
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,243 0001506377709 1901085012140001
361
KANZIA ISLAMIA
PESERTA
10/12/2014
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,244 0001506377711 1901084507480001
362
ZUBAIDAH
PESERTA
05/07/1948
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,245 0001506377722 1901081409800001
362
MUHAMMAD MURTADHA
ANAK
15/09/1980
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,246 0001506377733 1901084710890001
362
NUR HALIMAH
ANAK
21/10/1988
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,247 0001506377744 1901080507690003
365
KALENCEM
PESERTA
05/07/1969
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,248 0001506377755 1901085103730001
365
SUSILAWATI
ISTRI
11/03/1973
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,249 0001506377766 1901083006900001
365
SOPIAN
ANAK
30/06/1990
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,250 0001506377777 1901081910930001
365
NOPI
ANAK
19/10/1993
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,251 0001506377788 1901082212950001
365
REIMONDO
ANAK
22/12/1995
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,252 0001506377799 1901082505990002
365
GUSDUR
ANAK
25/05/1999
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,253 0001506377801 1901081412010001
365
ABDULLAH
ANAK
14/12/2001
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,254 0001506377812 1901081902120001
365
AKHIRUDIN
ANAK
19/02/2012
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,255 0001506377823 1901086010610001
373
SOBHI
PESERTA
20/10/1958
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,256 0001506377834 1901082006930001
373
ABDUL ROZIK
ANAK
20/06/1993
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,257 0001506377845 1901081607580001
375
REDI
PESERTA
16/07/1958
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,258 0001506377856 1901081303770001
376
AWALUDIN
PESERTA
13/03/1977
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,259 0001506377867 1901085405780002
376
INUN
ISTRI
14/05/1978
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,260 0001506377878 1901081307090001
376
AJAT
ANAK
13/07/2009
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,261 0001506377889 1901080105140001
376
ARJI
ANAK
01/05/2014
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 55 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,262 0001506377891 1901084605830002
380
ARJUNA
PESERTA
06/05/1983
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,263 0001506377902 1901085011370001
381
ROMLAH
PESERTA
10/11/1937
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,264 0001506377913 1901084701830013
382
ICUT
PESERTA
07/01/1983
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,265 0001506377924 1901082512120001
383
GIO ANGGARA
PESERTA
26/12/2012
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,266 0001506377935 1901083110660001
384
ABU RAHMAT
PESERTA
31/10/1966
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,267 0001506377946 1901084310870002
384
ROTENUN
ISTRI
03/10/1987
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,268 0001506377957 1901086108940001
384
UTARI AGUSTIN
ANAK
21/08/1994
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,269 0001506377968 1901081508100001
384
RIDO ILAHI
ANAK
15/08/2010
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,270 0001895652325 1901082706030002
384
DANI SAPUTRA
TAMBAHAN
27/06/2003
PUDING BESAR
01/11/2015
AKTIF
19,225
19/10/2015
1,271 0001506377979 1901084701800018
388
YUTIARTI
PESERTA
07/01/1980
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,272 0001506377981 1901080502740001
389
ROSIDI
PESERTA
05/02/1974
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,273 0001506377992 1901084510760001
389
JUMINAH
ISTRI
05/10/1976
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,274 0001506378003 1901085803020001
389
LIDIANA
ANAK
18/03/2002
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,275 0001506378014 1901081606140001
392
YENDRI
PESERTA
16/05/2014
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,276 0001506378025 1901084701580004
393
MARWAH
PESERTA
30/01/1961
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,277 0001506378036 1901080701920006
393
ABDULLAHA
ANAK
10/07/1992
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,278 0001506378047 1901080511750001
395
DIKI SUPRASTIONO
PESERTA
05/11/1975
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,279 0001506378058 1901084311810001
395
HARYANTI
ISTRI
03/11/1981
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,280 0001506378069 1901082110070002
395
JUDIT JASSARI
ANAK
21/10/2007
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,281 0001506378071 1901085906570001
398
MARIANA
PESERTA
19/06/1957
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,282 0001506378082 1901080710820002
398
RIZAL
ANAK
07/10/1982
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,283 0001506378093 1901084612960002
398
SONETA
ANAK
06/12/1996
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,284 0001506378104 1901080704760001
401
JUMADI
PESERTA
07/04/1976
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 56 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,285 0001506378115 1901085508850002
401
AGUSTINAWATI
ISTRI
15/08/1985
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,286 0001506378126 1901082306030004
401
EPRI JUNIARTI
ANAK
23/08/2003
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,287 0001506378137 1901085403110001
401
AMIRA SELVIANI
ANAK
14/03/2011
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,288 0001506378148 1901080908710001
405
BASTARI
PESERTA
09/08/1971
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,289 0001506378159 1901086808750001
405
HATIJAH
ISTRI
28/08/1975
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,290 0001506378161 1901082106960001
405
MARATUL ROSIDAH
ANAK
22/06/1996
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,291 0001506378172 1901081212980002
405
AHMAD TIJANI
ANAK
12/12/1998
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,292 0001506378183 1901081102040002
405
IMAM QOZALI
ANAK
11/02/2004
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,293 0001506378194 1901084907080001
405
NADIA
ANAK
19/07/2008
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,294 0001506378205 1901080204770002
411
SUBARTO
PESERTA
02/04/1977
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,295 0001506378216 1901085507820001
411
SITI ROHANI
ISTRI
15/07/1982
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,296 0001506378227 1901085309010001
411
RESMA SEPTIANA
ANAK
13/09/2001
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,297 0001506378238 1901085506110002
411
RISKA AGUSTINA
ANAK
15/08/2011
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,298 0001506378249 1901080701790004
415
SUPANTRI
PESERTA
07/01/1979
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,299 0001506378251 1901084701800006
415
LINA
ISTRI
07/01/1980
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,300 0001506378262 1901084907960001
415
YENI WAHYUNI
ANAK
06/09/1996
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,301 0001506378273 1901084906020001
415
SONIA
ANAK
06/09/2002
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,302 0001506378284 1901081306070001
415
MUHAMMAD FARHAN
ANAK
13/04/2007
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,303 0001895653631 1901084901530001
415
ZAINAP
TAMBAHAN
09/01/1953
PUDING BESAR
01/11/2015
AKTIF
19,225
19/10/2015
1,304 0001506378295 1901080701670021
420
SUPARMIN
PESERTA
07/01/1967
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,305 0001506378306 1901084701700009
420
MASTI
ISTRI
07/01/1970
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,306 0001506378317 1901081511980002
420
PRIMA
ANAK
15/11/1998
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,307 0001506378328 1901081204050001
420
BARI
ANAK
12/04/2005
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 57 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,308 0001506378339 1901080701840009
424
IBRAHIM
PESERTA
07/01/1984
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,309 0001506378341 1901084708880001
424
SURYANA
ISTRI
08/07/1988
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,310 0001506378352 1901082510710001
426
JUMADI
PESERTA
05/05/1969
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,311 0001506378363 1901084701760018
426
DAMAYANTI
ISTRI
07/01/1976
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,312 0001506378374 1901081707960002
426
ARIE ADREAN
ANAK
17/07/1996
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,313 0001506378385 1901080211010002
426
DWI NOVRIAN
ANAK
02/11/2001
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,314 0001506378396 1901084307070001
426
ANDREA TRI JULIANI
ANAK
03/07/2007
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,315 0001506378407 1901082512700001
431
SUPIT
PESERTA
25/12/1970
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,316 0001506378418 1901084406720002
431
ROHANA
ISTRI
06/06/1972
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,317 0001506378429 1901086004980001
431
SANTI KUSANTARI
ANAK
20/04/1998
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,318 0001506378431 1901084905080001
431
DINDA
ANAK
09/05/2008
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,319 0001506378442 1901085401110001
431
REVITA SUPIYANA DEWI
ANAK
14/01/2011
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,320 0001506378453 1901080701480001
436
TASLI
PESERTA
07/01/1948
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,321 0001506378464 1901084701570011
436
LUTIAH
ISTRI
07/01/1957
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,322 0001506378475 1901082510790001
436
ARBIAN
ANAK
25/10/1979
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,323 0001506378486 1901080702810001
436
ASRI
ANAK
07/02/1981
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,324 0001506378497 1901080701850002
436
ASLAN
ANAK
07/01/1985
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,325 0001506378508 1901080102710001
441
BAHTIAR
PESERTA
01/02/1971
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,326 0001506378519 1901086505770001
441
KAMSIAH
ISTRI
15/05/1977
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,327 0001506378521 1901082512020001
441
AMAR MA'RUP
ANAK
25/12/2002
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,328 0001506378532 1901081503110001
441
AZAM SAPUTRA
ANAK
15/03/2011
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,329 0001895655137 1901084810550001
441
ERNA
TAMBAHAN
08/10/1955
PUDING BESAR
01/11/2015
AKTIF
19,225
19/10/2015
1,330 0001506378543 1901080701870005
445
SUTRI
PESERTA
07/01/1987
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 58 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,331 0001506378554 1901086501950002
445
EVI
ANAK
25/01/1995
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,332 0001506378565 1901086603140001
445
PUTRI HARUM
ANAK
26/03/2014
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,333 0001506378576 1901080701550014
448
MUAD
PESERTA
07/01/1955
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,334 0001506378587 1901084701580014
448
MUTIARA
ISTRI
07/01/1958
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,335 0001506378598 1901080701840006
448
ZAKI
ANAK
07/01/1984
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,336 0001506378609 1901081201660001
451
AMIT
PESERTA
12/01/1966
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,337 0001506378611 1901086004670001
451
SARNI
ISTRI
20/04/1967
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,338 0001506378622 1901081608920002
451
MUNIR
ANAK
16/08/1992
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,339 0001506378633 1901081506990004
451
JODI
ANAK
16/06/1999
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,340 0001506378644 1901081307110001
451
CANDRA
ANAK
13/07/2011
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,341 0001506378655 1901080305710001
456
RIDUAN
PESERTA
03/05/1971
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,342 0001506378666 1901086510960002
456
NURUL FADILAH
ANAK
25/01/1996
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,343 0001506378677 1901086105970002
456
SITI JULAIHO
ANAK
21/05/1997
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,344 0001506378688 1901082005980002
456
M. ABROL
ANAK
20/05/1998
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,345 0001506378699 1901086204000003
456
HAFIFAH
ANAK
22/04/2000
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,346 0001506378701 1901081111030003
456
ANSORI
ANAK
11/11/2003
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,347 0001506378712 1901080806050001
456
AKLI
ANAK
08/06/2005
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,348 0001506378723 1901082401070002
456
AFDOL
ANAK
24/01/2007
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,349 0001506378734 1901082011080002
456
AZHAR
ANAK
20/11/2008
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,350 0001506378745 1901080206100002
456
ARKAN
ANAK
02/06/2010
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,351 0001506378756 1901086412130001
456
RIKA NURHAYATI
ANAK
24/12/2013
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,352 0001506378767 1901081502850001
467
JUNAIDI
PESERTA
15/02/1985
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,353 0001506378778 1901084701840002
467
YUYUN ASTUTI
ISTRI
07/01/1984
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 59 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,354 0001506378789 1901081812140001
467
MUHAMAD SAPRI YUDI
ANAK
18/12/2014
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,355 0001506378791 1901085405620001
470
TIMI
PESERTA
14/05/1962
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,356 0001506378802 1901084210910001
470
WAHYULITA
ANAK
02/10/1991
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,357 0001506378813 1901083010000001
470
DIDI FIRNANDA
ANAK
30/10/2000
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,358 0001506378824 1901084701600006
473
SITI
PESERTA
07/01/1960
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,359 0001506378835 1901081504570001
474
BAHTIAR
PESERTA
15/04/1957
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,360 0001506378846 1901085102570001
474
SIDA
ISTRI
11/02/1957
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,361 0001506378857 1901085910750001
474
YOHANI
ANAK
19/10/1975
PUDING BESAR
01/11/2015
AKTIF
19,225
15/10/2015
1,362 0001506378868 1607140102400002
477
Kasbi
PESERTA
02/01/1948
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,363 0001506378879 1607144101450005
477
Supiyah
ISTRI
01/01/1945
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,364 0001506378881 1901014706510003
479
Marhena
PESERTA
06/07/1951
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,365 0001506378892 1901011404900007
479
Sulin
ANAK
14/04/1990
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,366 0001506378903 1901011507920004
479
Andika
ANAK
15/07/1992
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,367 0001506378914 1901010902980009
479
Samson
ANAK
02/09/1998
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,368 0001506378925 1901014203770003
483
Nyuk Yin
PESERTA
03/02/1977
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,369 0001506378936 1901014707020001
483
Angela Chai
ANAK
07/07/2002
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,370 0001506378947 1901016801080001
483
Veby Jeniver
ANAK
28/01/2008
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,371 0001506378958 1901010905760005
486
Iswadi
PESERTA
05/09/1976
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,372 0001506378969 1901014707770014
486
Nurmala
ISTRI
07/07/1977
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,373 0001506378971 1901011809980001
486
Muhammad Nur Ichsan
ANAK
18/09/1998
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,374 0001506378982 1901010206020002
486
Muhammad Wisam
ANAK
02/06/2002
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,375 0001506378993 1901014508070002
486
Uliyatin
ANAK
08/05/2007
KENANGA
01/11/2015
AKTIF
19,225
15/10/2015
1,376 0001506379004 1901013110460002
491
Andi Mukasau
PESERTA
31/10/1946
SUNGAILIAT
01/11/2015
AKTIF
19,225
15/10/2015
12/2/15 3:15 PM
Page 60 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,377 0001506379015 1901016006610002
491
Yuniati
ISTRI
20/06/1961
SUNGAILIAT
01/11/2015
AKTIF
19,225
15/10/2015
1,378 0001506379026 1901012007940003
491
Dedi Juhadi
ANAK
20/07/1994
SUNGAILIAT
01/11/2015
AKTIF
19,225
15/10/2015
1,379 0001506379037 1901015802960002
491
Lili Anggita
ANAK
18/02/1996
SUNGAILIAT
01/11/2015
AKTIF
19,225
15/10/2015
1,380 0001601798231 1901015803350000
LIE DJOEN LUAI
PESERTA
18/03/1935
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,381 0001601798242 1901011810630001
LIE SIONG TO
ANAK
18/10/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,382 0001601798253 1901011909830007
IRWAN
PESERTA
19/09/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,383 0001601798264 1901016301880001
EVA NURLAELY JANITA SARI
ISTRI
23/01/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,384 0001601798275 1901011001090000
LOUIS ANTHONY
ANAK
10/01/2009
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,385 0001601798286 1901011512110001
NIXOEN EVAN ANTHONY
ANAK
15/12/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,386 0001601798297 1901016503140001
XELLIA VILLONIA
ANAK
25/03/2014
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,387 0001601798308 1901010706790004
JOHAN
PESERTA
07/06/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,388 0001601798319 1901015906870005
RISNAWATI
ISTRI
19/06/1987
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,389 0001601798321 1901012501080002
FLORO CHRYSTALLONS
ANAK
25/01/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,390 0001601798332 1901012202110001
FLORIZONE CHRYSTALLONS
ANAK
22/02/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,391 0001601798343 1901010602700001
12
CHANDRA
PESERTA
02/06/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,392 0001601798354 1901016009710002
12
AIJ NOEN
ISTRI
20/11/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,393 0001601798365 1901016210010002
12
MICHELLA MARRISCA
CHANDRA
ANAK
22/10/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,394 0001601798376 1901010401050004
12
HESSEL GERALD STEVEN
ANAK
04/01/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,395 0001601798387 1901012805060002
12
LEONARD WILLIAM
ANAK
28/05/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,396 0001601798398 1901014911410001
21
TJUNG SUN TJIANG
PESERTA
11/09/1941
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,397 0001601798409 1901011510720001
21
AI SEN
ANAK
15/10/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,398 0001601798411 1901011405790001
21
DENNI WIJAYA
ANAK
14/05/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,399 0001601798422 1901011111850019
24
SUPRAPTO
PESERTA
11/11/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 61 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,400 0001601798433 1901014905900002
24
MARYAM SARI
ISTRI
04/05/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,401 0001601798444 1901010705130001
24
ALIF MUFLIHUN
ANAK
07/05/2013
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,402 0001601798455 1901012908570001
29
LIOE MEN HIONG
PESERTA
29/08/1957
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,403 0001601798466 1901016704990003
29
ANITA SURIH
ANAK
27/04/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,404 0001601798477 1901012101500003
31
IDRIS
PESERTA
21/01/1950
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,405 0001601798488 1901016006570002
31
YAMINAH
ISTRI
20/06/1957
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,406 0001601798499 1901011108880005
33
SUPRIYADI
PESERTA
11/08/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,407 0001601798501 3301054103920006
33
SUNARSIH
ISTRI
01/03/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,408 0001601798512 1901012911130002
33
SHOFY ZAINUL ARIFIN
ANAK
29/11/2013
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,409 0001601798523 1901012201890005
39
DEDI MAULIDI
PESERTA
22/01/1989
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,410 0001601798534 1901015311920005
39
SITI AISYAH
ISTRI
13/11/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,411 0001601798545 1901011310030002
39
YUSUF PERMADI
ANAK
14/12/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,412 0001601798556 1901013103080001
39
RISKI RAHMAT GUNAWAN
ANAK
31/03/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,413 0001601798567 1901011412080002
39
BUJANG SARIP HIDAYAT
ANAK
14/12/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,414 0001601798578 1901013108860002
39
RUSDIYANSAH
ANAK
31/08/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,415 0001601798589 1901014706650003
39
RODIAH
TAMBAHAN
07/06/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,416 0001601798591 1901011412840003
39
AAN SUHARDI
TAMBAHAN
14/12/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,417 0001601798602 1901016408850001
44
SANTI ERYANTI
PESERTA
24/08/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,418 0001601798613 1901010106000006
44
APITUS HERIYANTO
ANAK
01/06/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,419 0001601798624 1901011006040002
44
FERRY YANTO ALDY
ANAK
06/10/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,420 0001601798635 1901011901640002
49
NGAN TJIN FUI
PESERTA
19/01/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,421 0001601798646 1901016912600003
49
DJONG PIT LIAN
ISTRI
29/12/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,422 0001601798657 1901010909920001
49
FERRY MARTIN
ANAK
09/09/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 62 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,423 0001601798668 1901015503970001
49
RIA SILVIANA
ANAK
15/03/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,424 0001601798679 1901013112980001
49
TONI MARTIN
ANAK
31/12/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,425 0001601798681 1901017009400001
54
NGAN A LIAN
PESERTA
30/09/1940
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,426 0001601798692 1901010303720001
54
NGAN A KHIN
ANAK
30/03/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,427 0001601798703 1901012807750001
54
NGAN A FO
ANAK
28/07/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,428 0001601798714 1901012306780004
57
SUI JEN
PESERTA
23/06/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,429 0001601798725 1901010703600002
58
ON SUN KHIONG
PESERTA
03/07/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,430 0001601798736 1901014302680001
58
DJONG TIT NIE
ISTRI
03/02/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,431 0001601798747 1901013106670001
61
AMIN
PESERTA
30/06/1967
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,432 0001601798758 1901014207710001
61
NGIT FA
ISTRI
07/02/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,433 0001601798769
61
SILVIA
ANAK
05/08/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,434 0001601798771 1901015211020001
61
SELFIYA KERISTINA
ANAK
11/01/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,435 0001601798782 1901014704770003
65
LIE KWAN SIN
PESERTA
07/04/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,436 0001601798793 1901017101950002
65
HERMAN
ANAK
22/09/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,437 0001601798804 1901012209980002
65
YANNI
ANAK
31/01/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,438 0001601798815 1901011612020004
65
SILVIA
ANAK
26/12/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,439 0001601798826 1901012209760001
69
LIE MUK HIUNG
PESERTA
22/09/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,440 0001601798837 1901016508860014
69
DEWI YATI
ISTRI
25/08/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,441 0001601798848 1901012008050004
69
DIMAS DIAN ZAPUTRA
ANAK
20/08/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,442 0001601798859 1901014106090002
69
FLORENSIA VERONICA
ANAK
01/08/2009
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,443 0001601798861 1901012504770010
74
SAK MIN FU
PESERTA
25/04/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,444 0001601798872 1901016309840001
74
YANTI
ISTRI
23/09/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,445 0001601798883 1901014911050001
74
NOVELA
ANAK
09/10/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 63 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,446 0001601798894 1901012303840005
77
YANTO
PESERTA
23/03/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,447 0001601798905 1901015406830006
77
MARLINA
ISTRI
14/06/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,448 0001601798916 1901011109030003
77
VEBERIANSYAH
ANAK
11/09/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,449 0001601798927 1901015502110001
77
LOURENSIA MOURENATA
ANAK
15/02/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,450 0001601798938 1901010708770001
82
MUK KHIONG
PESERTA
08/07/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,451 0001601798949 1901016004810001
82
SIOU PING
ISTRI
20/04/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,452 0001601798951 1901010811020001
82
KELVIN ALFRANDO
ANAK
08/11/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,453 0001601798962 1901010307050001
82
STEVEN ALFRANDO
ANAK
07/03/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,454 0001601798973 1901012711120001
82
JUSTIN ALFRANDO
ANAK
27/11/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,455 0001601798984 1901076001900001
87
HE RY
PESERTA
20/01/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,456 0001601798995 1901016208120003
87
SILVI
ANAK
22/08/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,457 0001601799006 1901012609370002
89
BUN LIUNG MEN
PESERTA
26/09/1937
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,458 0001601799017 1901015810420002
89
BONG NYOEK DJIM
ISTRI
18/10/1942
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,459 0001601799028 1901014505630011
93
TJHIN NYUK HIONG
PESERTA
05/05/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,460 0001601799039 1901015811670002
93
TJHIN NYUK LIAN
TAMBAHAN
18/11/1967
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,461 0001601799041 1901011707310002
95
TJHIN DJIT KOEIJ
PESERTA
17/07/1931
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,462 0001601799052 1901015209380001
95
TJHANG MOI TIT
ISTRI
12/09/1938
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,463 0001601799063 1901014610490001
97
BONG NGIM HIONG
PESERTA
06/10/1949
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,464 0001601799074 1901015508660002
98
KON TJHIAN
PESERTA
15/08/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,465 0001601799085 1901011007920002
98
JEFRI
ANAK
10/07/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,466 0001601799096 1901014509930004
98
FANI
ANAK
09/05/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,467 0001601799107 1901011203620001
101
FU A TJIN
PESERTA
03/12/1962
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,468 0001601799118 1901016307670001
101
KIM LIE
ISTRI
23/07/1967
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 64 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,469 0001601799129 1901014710960001
101
MIGA AUDINA
ANAK
07/01/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,470 0001601799131 1901012311030001
101
FRANDI
ANAK
21/11/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,471 0001601799142 1901011705840003
105
KO BUN PHIN
PESERTA
17/05/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,472 0001601799153 1901015202640002
105
LIE MUK SIAN
ISTRI
12/02/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,473 0001601799164 1901012206860002
105
KIAN SUNG
ANAK
22/06/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,474 0001601799175 1901014805870001
105
MIE YING
ANAK
05/08/1987
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,475 0001601799186 1901015404900003
105
KO MEAN
ANAK
14/04/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,476 0001601799197 1901016802500002
110
TJHIN KIM LIAN
PESERTA
28/02/1950
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,477 0001601799208 1901011707800000
111
FREDDY
PESERTA
17/07/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,478 0001601799219 1901014312810004
111
CIT YAN
ISTRI
03/12/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,479 0001601799221 1901016403110003
111
JANICE LOVI FREYANCA LIM
ANAK
24/03/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,480 0001601799232 1901015704140001
111
BRIGITTA LOVI FREYANCA LIM ANAK
17/04/2014
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,481 0001601799243 1901010409570005
115
BUDI SUHERLAN
PESERTA
04/09/1957
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,482 0001601799254 1901011211960003
115
GUNAWAN
ANAK
14/10/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,483 0001601799265 1901014804000003
115
DEWI
ANAK
08/04/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,484 0001601799276 1901012007050002
115
CARRIYANTO
ANAK
20/07/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,485 0001601799287 1901011609670002
119
KHUN TUI
PESERTA
16/09/1967
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,486 0001601799298 1901012312730002
119
KHUN LIONG
TAMBAHAN
23/12/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,487 0001601799309 1901012804780003
119
KHUN MIN
TAMBAHAN
28/04/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,488 0001601799311 1901011111810003
119
KHUN LIUNG
TAMBAHAN
11/11/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,489 0001601799322 1901011906840002
119
KHUN AN
TAMBAHAN
19/06/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,490 0001601799333 1901010206670002
124
PEPEN
PESERTA
02/06/1967
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,491 0001601799344 1901010510810002
126
YANTO
PESERTA
05/10/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 65 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,492 0001601799355 1901011004790002
127
YULIANUS EKA PUTRA
PESERTA
10/04/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,493 0001601799366 1901015407140002
127
KEYLA VINCENSIA
ANAK
14/07/2014
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,494 0001601799377 1901012506740004
129
TJUNG SUN KON
PESERTA
25/06/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,495 0001601799388 1901014605610002
130
NGIAT NON
PESERTA
06/05/1961
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,496 0001601799399 1901010706880004
130
LING SAN
ANAK
07/06/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,497 0001601799401 1901014808950009
130
AP NGO
ANAK
08/08/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,498 0001601799412 1901010509460001
136
LIONG PIANG KHIE
PESERTA
09/05/1946
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,499 0001601799423 1901014306540004
136
LIN SIN LOIJ
ISTRI
06/03/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,500 0001601799434 1901011012670003
138
LO A SIAT
PESERTA
10/12/1967
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,501 0001601799445 1901014108730003
138
NGIAT LIE
ISTRI
01/08/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,502 0001601799456 1901010509980003
138
ALDI SETIAWAN
ANAK
05/09/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,503 0001601799467 1901011802010003
138
JEFFRY SETIAWAN
ANAK
18/02/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,504 0001601799478 1901014808040001
138
SIVIA AGUSTINA
ANAK
08/08/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,505 0001601799489 1901015207060001
138
TIA JULIANI
ANAK
12/07/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,506 0001601799491 1901011209670003
144
WITE
PESERTA
12/09/1987
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,507 0001601799502 1901015807840003
144
YENTI
ISTRI
18/07/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,508 0001601799513 1901010809070008
144
RICO RIKARDO
ANAK
08/09/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,509 0001601799524 1901010608100003
144
RICKY REVALDI
ANAK
06/08/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,510 0001601799535 1901012309700005
148
MEN KHIONG
PESERTA
23/09/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,511 0001601799546 1901015306720004
148
SIAUWMEY HIE
ISTRI
13/08/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,512 0001601799557 1901010809050006
148
VERDY
ANAK
09/08/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,513 0001601799568 1901015603120004
148
VEREN
ANAK
16/03/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,514 0001601799579 1901017009500002
152
TJHANG MOIJ THIN
PESERTA
30/09/1950
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 66 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,515 0001601799581 1901014408390001
153
BOEN A TJHAI
PESERTA
04/08/1939
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,516 0001601799592 1901014408530001
154
MARJAN AMAT
PESERTA
04/08/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,517 0001601799603 1901011111750001
154
SUN TJHIAM
ANAK
11/11/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,518 0001601799614 1901011205690001
156
PIT KHIONG
PESERTA
12/05/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,519 0001601799625 1901011110070002
156
STANLEY OKTOVIANUS
ANAK
11/10/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,520 0001601799636 1901010404730005
158
TJHANG HAP FONG
PESERTA
04/04/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,521 0001601799647 1901016510770006
158
MIE JUN
ISTRI
25/10/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,522 0001601799658 1901014809980006
158
BELLA
ANAK
08/09/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,523 0001601799669 1901016212990005
158
SILVIA
ANAK
22/12/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,524 0001601799671 1901011710010003
158
ARTON
ANAK
17/10/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,525 0001601799682 1901011609550002
163
SIM A DJAN
PESERTA
16/09/1955
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,526 0001601799693 1901011702740003
164
TJHIN NGIT KWET
PESERTA
17/02/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,527 0001601799704 1901016810070001
164
YURIA
ANAK
28/10/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,528 0001601799715 1901010101410001
166
TJHANG KIM LONG
PESERTA
01/01/1941
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,529 0001601799726 1901015809530001
166
PHOE SIAN NA
ISTRI
18/09/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,530 0001601799737 1901015910800011
166
TJONG A LIAN
ANAK
19/10/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,531 0001601799748 1901016210510005
169
TJOENG A TIK
PESERTA
22/10/1951
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,532 0001601799759 1901015301440001
170
TJONG TJO TJAI
PESERTA
13/01/1944
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,533 0001601799761 1901016003230001
171
SIAUW TJIT MA
PESERTA
20/03/1923
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,534 0001601799772 1901016106500001
171
SIAUW TJAUW TOEIJ
ANAK
21/06/1950
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,535 0001601799783 1901015703540002
171
KONG SAK LIAN
TAMBAHAN
17/03/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,536 0001601799794 1901011512850005
174
SUYONO
PESERTA
15/12/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,537 0001601799805 1901016402880002
174
ERNAWATI
ISTRI
24/02/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 67 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,538 0001601799816 1901016712120001
174
DELVIA FIORENZA
ANAK
27/12/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,539 0001601799827 1901011009630001
177
BEJO
PESERTA
10/09/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,540 0001601799838 1901014204690001
177
SUPRAPTI
ISTRI
02/04/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,541 0001601799849 1901010707930001
177
TESSA SAPUTRA
ANAK
07/07/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,542 0001601799851 1901010604030001
177
SENDI
ANAK
04/06/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,543 0001601799862 1901012707510003
181
BONG THU WONG
PESERTA
27/07/1951
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,544 0001601799873 1901015101530001
181
SIM A TJIT
ISTRI
01/11/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,545 0001601799884 1901014309830001
181
ICE VIRGIYANI
ANAK
03/09/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,546 0001601799895 1901010203870001
181
SUKAMDANI
ANAK
02/03/1987
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,547 0001601799906 1901010106540001
185
TURRIADI
PESERTA
01/06/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,548 0001601799917 1901014303730005
185
MISTIA
ISTRI
03/03/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,549 0001601799928 1901011302970002
185
MULYADI
ANAK
13/02/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,550 0001601799939 1901014506980003
185
JUNIANTI
ANAK
05/06/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,551 0001601799941 1901016707050003
185
YULISA
ANAK
27/07/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,552 0001601799952 1901016403400001
190
TJEN PO LUI
PESERTA
24/03/1940
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,553 0001601799963 1901015812680003
190
AY LIE
ISTRI
16/12/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,554 0001601799974 1901010903660001
192
TJHIN TJHEN
PESERTA
09/03/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,555 0001601799985 1901014509630001
192
MIE NYU
ISTRI
09/05/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,556 0001601799996 1901010405890001
192
YOHANES
ANAK
04/05/1989
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,557 0001601800007 1901011901930001
192
MATIUS SUKRISNO MUKTI
ANAK
19/01/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,558 0001601800018 1901015105660001
196
RIKEM
PESERTA
11/05/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,559 0001601800029 1901016912990003
196
DESI SUSILAWATI
ANAK
29/12/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,560 0001601800031 1901010609570001
198
DULAKSAN BIN SANAWI
PESERTA
06/09/1957
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 68 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,561 0001601800042 1901016812750001
198
SRIYATUN BINTI MURONI
ISTRI
28/12/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,562 0001601800053 1901011605970001
198
ALVIANTO
ANAK
16/05/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,563 0001601800064 1901015605970001
198
WAODE PUTRI ASTUTI
ANAK
13/02/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,564 0001601800075 1901010202030001
198
ALMAN
TAMBAHAN
02/02/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,565 0001601800086 1901015511550001
203
TJHIN NYUK SIAN
PESERTA
15/11/1955
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,566 0001601800097 1901010706770001
203
TET FAT
ANAK
20/07/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,567 0001601800108 1901014105370001
205
LIW A LAN
PESERTA
01/05/1937
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,568 0001601800119 1901011705850001
206
HARJANTO
PESERTA
17/05/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,569 0001601800121 1901016606860001
206
EKA NUR FITRIYANTI
ISTRI
26/06/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,570 0001601800132 1901010511620004
208
KON DJIE HIN
PESERTA
05/11/1962
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,571 0001601800143 1901014507650005
208
LIE SAK MIN
ISTRI
05/07/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,572 0001601800154 1901012210360002
211
BOEN TEN NGIAN
PESERTA
22/10/1936
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,573 0001601800165 1901014409450001
211
SIM SOEN NGIT
ISTRI
04/09/1945
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,574 0001601800176 1901015006680001
214
SIM SAK JIN
PESERTA
10/06/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,575 0001601800187 1901011511980001
214
HENDRI
ANAK
15/11/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,576 0001601800198 1901016705000003
214
LIANITA
ANAK
27/05/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,577 0001601800209 1901015007660001
218
LASEMI
PESERTA
10/07/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,578 0001601800211 1901012103450001
222
BONG TU FUK
PESERTA
21/03/1945
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,579 0001601800222 1901015506470003
222
BUN LIAN TJI
ISTRI
15/06/1947
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,580 0001601800233 1901010802680001
224
KOK KIM FOE
PESERTA
08/02/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,581 0001601800244 1901015801690001
224
NG SOEI NGIT
ISTRI
18/01/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,582 0001601800255 1901014212960003
224
OKTAVIA AMELIA
ANAK
02/12/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,583 0001601800266 1901015804020001
224
APRILIANA YOLANDA
ANAK
18/04/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 69 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,584 0001601800277 1901012904650001
228
SAK YUNG
PESERTA
29/04/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,585 0001601800288 1901016402730003
228
MIE NON
ISTRI
24/02/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,586 0001601800299 1901010109940002
228
ARIE SHANDY SAPUTRA
ANAK
01/09/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,587 0001601800301 1901012506970010
228
CHANDRA WIRANGGA
SAPUTRA
ANAK
25/08/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,588 0001601800312 1901010106640001
232
SOEI SIONG
PESERTA
01/06/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,589 0001601800323 1901016302700001
232
MUK TI
ISTRI
23/02/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,590 0001601800334 1901014209060001
232
FRANSISCA LIA PARAMITA
ANAK
02/09/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,591 0001601800345 1901012802510004
236
LIE MUI TET
PESERTA
28/02/1951
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,592 0001601800356 1901016705500005
236
JULIANA WAHI
ISTRI
27/05/1950
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,593 0001601800367 1901015509470001
244
TJHANG A MOEN
PESERTA
15/09/1947
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,594 0001601800378 1901011309600001
244
TJHANG KONG CHING
ANAK
13/09/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,595 0001601800389 1901011802830001
244
TJHANG KONG YAUW
ANAK
18/02/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,596 0001601800391 1901012005530001
249
LIU DJAN CAI
PESERTA
20/05/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,597 0001601800402 1901017011530001
249
NG KON KHIUN
ISTRI
30/11/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,598 0001601800413 1901010308870001
249
YUYANTO
ANAK
08/03/1987
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,599 0001601800424 1901012812880001
249
JONO
ANAK
28/12/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,600 0001601800435 1901014112910001
249
YULIWATI
ANAK
12/01/1991
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,601 0001601800446 1901016202500001
254
LIE A DJIN
PESERTA
22/02/1950
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,602 0001601800457 1901012501590003
255
TJHIN KON KHIN
PESERTA
25/01/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,603 0001601800468 1901016812610001
255
LIE MIE LIE
ISTRI
28/12/1961
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,604 0001601800479 1901010502620003
257
LIE SUI PO
PESERTA
05/02/1962
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,605 0001601800481 1901014512700002
257
THEN NGIAT CHING
ISTRI
05/12/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,606 0001601800492 1901011203960001
257
FEBRI
ANAK
12/03/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 70 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,607 0001601800514 1901010601610005
261
DJAP A KHUI
PESERTA
06/01/1961
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,608 0001601800525 1901016807550002
261
NG KIM SOE
ISTRI
28/07/1955
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,609 0001601800536 1901010811900003
261
ASIAN GUNAWAN
ANAK
08/11/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,610 0001601800547 1901014607430001
264
NG KIM FA
PESERTA
06/07/1943
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,611 0001601800558 1901011111800003
265
YUNGYUNG
PESERTA
11/11/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,612 0001601800569 1901011001830004
265
JONI SUSANTO
TAMBAHAN
10/01/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,613 0001601800571 1901010107840014
265
IWAN SURIYONO
TAMBAHAN
01/07/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,614 0001601800582 1901010401964003
269
MULYADI
PESERTA
04/01/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,615 0001601800593 1901015002660004
269
ZAINAP
ISTRI
10/02/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,616 0001601800604 1901011405930001
269
WENDRI
ANAK
14/05/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,617 0001601800615 1901015511940001
269
NURSIAH
ANAK
15/11/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,618 0001601800626 1901011210010006
269
HAIRUL SOLEH
ANAK
12/10/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,619 0001601800637 1901015103030003
269
MARTINI
ANAK
11/03/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,620 0001601800648 1901015504570001
275
SABANIAH
PESERTA
15/04/1957
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,621 0001601800659 1901015901910001
275
SUPIANIH
ANAK
19/01/1991
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,622 0001601800661 1901010501550001
277
IDRUS BIN SALAM
PESERTA
05/01/1955
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,623 0001601800672 1901011708830001
277
INDRA
ANAK
17/08/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,624 0001601800683 1901011508930001
277
AGUSTIAR
ANAK
15/08/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,625 0001601800694 1901016311990002
277
IRLIN RUSTIA
ANAK
23/11/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,626 0001601800705 1901012903580003
281
GANI
PESERTA
29/03/1958
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,627 0001601800716 1901014107470003
281
JAUYAH
ISTRI
01/07/1947
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,628 0001601800727 1901017112540004
283
MINI
PESERTA
31/12/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,629 0001601800738 1901010704730000
284
AFNI
PESERTA
07/04/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 71 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,630 0001601800749 1901016306710001
284
NENENG
ISTRI
23/06/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,631 0001601800751 1901010104000001
284
SABDA ALAMSYAH
ANAK
01/04/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,632 0001601800762 1901011310030001
284
ALFIAN
ANAK
13/10/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,633 0001601800773 1901010304840003
289
KARNAWAN
PESERTA
03/04/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,634 0001601800784 1901012602980002
289
KARDANU
ANAK
26/02/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,635 0001601800795 1901012311760005
291
RAMLAN
PESERTA
23/11/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,636 0001601800806 1901014911790004
291
BAHLINA
ISTRI
09/11/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,637 0001601800817 1901011409990001
291
BAHTIAR
ANAK
14/09/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,638 0001601800828 1901011809040001
291
BASRAN
ANAK
18/09/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,639 0001601800839 1901010909650001
295
TOYIB
PESERTA
09/09/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,640 0001601800841 1901015804750001
295
RUSMINI
ISTRI
18/04/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,641 0001601800852 1901012512980001
295
TOMMY
ANAK
25/12/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,642 0001601800863 1901016304030003
295
MISNAWATI
ANAK
23/04/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,643 0001601800874 1901016005090002
295
MUTIARA
ANAK
20/05/2009
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,644 0001601800885 1901010908530000
300
BAHARUN
PESERTA
09/08/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,645 0001601800896 1901015303590001
300
KARTINI
ISTRI
13/03/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,646 0001601800907 1901016310850001
300
BAHRATI
ANAK
23/10/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,647 0001601800918 1901012810880001
300
ROBIANSAH
ANAK
28/10/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,648 0001601800929 1901012706880001
305
SADAM
PESERTA
27/06/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,649 0001601800931 1901012008940001
305
SARDI
ANAK
20/08/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,650 0001601800942 1901016410700005
309
KEMAH
PESERTA
24/10/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,651 0001601800953 1901011600393002
309
DODI
ANAK
16/03/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,652 0001601800964 1901010101040006
309
YON
ANAK
01/01/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 72 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,653 0001601800975 1901011111070004
309
ALDO
ANAK
11/11/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,654 0001601800986 1901016502590003
314
ROMUNAH
PESERTA
25/02/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,655 0001601800997 1901012805900007
314
ROSMET
ANAK
28/05/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,656 0001601801008 1901014107540014
316
HAMINAH
PESERTA
01/07/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,657 0001601801019 1901011603860001
317
KAMALUDIN
PESERTA
16/03/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,658 0001601801021 1901014907880001
317
ULYANA
ISTRI
09/07/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,659 0001601801032 1901011412070001
317
MUHAMAD ULUL HAZAMI
ANAK
14/12/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,660 0001601801043 1901016406540000
320
MIDOI
PESERTA
24/05/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,661 0001601801054 1901014910570002
321
KASIAH
PESERTA
09/10/1957
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,662 0001601801065 1901014805930007
321
RAHAYU
ANAK
08/05/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,663 0001601801076 1901013103690002
323
EBI REPLIANTO
PESERTA
31/03/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,664 0001601801087 1901014709650004
323
SITI MURNI
ISTRI
07/09/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,665 0001601801098 1901015405060002
323
HURIAH ULFA RAHMAWATI
ANAK
14/05/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,666 0001601801109 1901010507550004
326
SAKDIN
PESERTA
05/07/1955
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,667 0001601801111 1901010310950001
326
MIDUN
ANAK
03/10/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,668 0001601801122 1901011009960001
326
EDI
ANAK
10/09/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,669 0001601801133 1901012303970001
326
HENDI
ANAK
23/03/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,670 0001601801144 1901011204600000
330
MUSTAR
PESERTA
12/04/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,671 0001601801155 1901012108780001
332
GUSWANTO
PESERTA
21/08/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,672 0001601801166 1901015405030001
332
PUTRI MAULIANI
ANAK
14/05/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,673 0001601801177 1901010508830002
335
GUSLI
PESERTA
05/08/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,674 0001601801188 1901011911870003
337
AMRULLAH
PESERTA
19/11/1987
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,675 0001601801199 1901015110930002
337
HETI
ISTRI
11/10/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 73 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,676 0001601801201 1901010301720003
339
SUDIRYANTO
PESERTA
03/01/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,677 0001601801212 1901016606760001
339
KARNILA
ISTRI
26/06/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,678 0001601801223 1901012307970007
339
ADITYA GUNAWAN
ANAK
23/07/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,679 0001601801234 1901012711030002
339
ANGGA SYAHPUTRA
ANAK
27/11/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,680 0001601801245 1901012908610001
343
BUJOD
PESERTA
29/08/1961
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,681 0001601801256 1901016809630003
343
SATIPAH
ISTRI
28/09/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,682 0001601801267 1901010108020003
343
YOGI SAPUTRA
ANAK
01/08/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,683 0001601801278 1901014501610003
346
ASNINA
PESERTA
05/01/1961
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,684 0001601801289 1901010410060007
346
ROMADHON
ANAK
04/10/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,685 0001601801291 1901013005340001
349
HAMDAN
PESERTA
30/05/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,686 0001601801302 1901016505880001
349
SURIAH
ANAK
25/06/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,687 0001601801324 1901011205710000
352
ASRI
PESERTA
12/05/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,688 0001601801335 1901014910780000
352
YULIANA
ISTRI
09/10/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,689 0001601801346 1901011507980000
352
YULIANRI KRISMUN
ANAK
15/07/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,690 0001601801357 1901012009020000
352
HERLI IRAWAN
ANAK
20/09/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,691 0001601801368 1901010609580001
356
YATI
PESERTA
06/09/1958
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,692 0001601801379 1901010810760005
356
BAHADAR
ANAK
08/10/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,693 0001601801381 1901010107910017
356
RENO REGAR
ANAK
01/07/1991
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,694 0001601801392 1901014502950006
356
DEVI
ANAK
05/02/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,695 0001601801403 1901010311840002
360
RUSTAMI
PESERTA
03/11/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,696 0001601801414 1901011203890005
360
HENDRA
TAMBAHAN
12/03/1989
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,697 0001601801425 1901011806850005
362
SUPRIATNO
PESERTA
18/06/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,698 0001601801436 1901015205830003
362
WIWIN
ISTRI
12/05/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 74 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,699 0001601801447 1901012805070002
362
DANNY PRATAMA
ANAK
28/05/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,700 0001601801458 1901017007140001
362
SAFITRI JULIYANTI
ANAK
30/07/2014
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,701 0001601801469 1901012707660003
366
MUHAMMAD
PESERTA
27/07/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,702 0001601801471 1901015312680001
366
SAPARIAH
ISTRI
13/12/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,703 0001601801482 1901010402900002
366
FERRY
ANAK
04/02/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,704 0001601801493 1901014203720002
371
NURSANAH
PESERTA
02/03/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,705 0001601801504 1901016507970001
371
ANURUL
ANAK
25/07/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,706 0001601801515 1901014406040004
371
WIRANTI
ANAK
04/06/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,707 0001601801526 1901016408100009
371
AZAHROTUL PALAH
ANAK
21/08/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,708 0001601801537 1901010507410001
375
LAHA
PESERTA
05/07/1941
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,709 0001601801548 1901010806740003
375
ROHIDI
ANAK
08/06/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,710 0001601801559 1901012007840005
375
GUSNAWAN
ANAK
20/07/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,711 0001601801561 1901015308880001
375
RONAH
ANAK
13/08/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,712 0001601801572 1901012703880003
380
MAHADI
PESERTA
27/03/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,713 0001601801583 1901015112700005
384
ROHINA
PESERTA
11/12/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,714 0001601801594 1901016304940001
384
TERIYANTI
ANAK
23/04/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,715 0001601801605 1901012002010002
384
ROHIT
ANAK
20/02/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,716 0001601801616 1901011611740001
387
HANAN
PESERTA
16/11/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,717 0001601801627 1901015610790001
387
ARMAH
ISTRI
16/10/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,718 0001601801638 1901010410990004
387
DENDY
ANAK
04/10/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,719 0001601801649 1901010110060009
387
ASRAN
ANAK
01/10/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,720 0001601801651 1901012004720000
391
SAMAWI
PESERTA
20/04/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,721 0001601801662 1901016705780000
391
SALMAH
ISTRI
27/05/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 75 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,722 0001601801673 1901011530460001
394
KALOK
PESERTA
13/04/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,723 0001601801684 1901010107630012
395
YULI
PESERTA
01/07/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,724 0001601801695 1901014107680010
395
SERIAH
ISTRI
01/07/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,725 0001601801706 1901012312860002
395
JANUAR
ANAK
23/12/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,726 0001601801717 1901014606430005
398
ZAIMI
PESERTA
06/06/1943
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,727 0001601801728 1901014808740001
398
AGUSTINA
ANAK
08/08/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,728 0001601801739 1901010309830005
400
SUWITO
PESERTA
03/09/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,729 0001601801741 1901010304630006
401
BASRUL
PESERTA
03/04/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,730 0001601801752 1901011705630002
402
SUDARTO UTU
PESERTA
17/05/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,731 0001601801763 1901015802730001
402
KARSATIK
ISTRI
18/02/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,732 0001601801774 1901015803930003
402
RAFITA
ANAK
18/03/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,733 0001601801785 1901011901030002
402
ARIANTO
ANAK
19/01/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,734 0001601801796 1901011407670003
408
WARSONO
PESERTA
14/07/1967
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,735 0001601801807 1901014207690000
408
SAINANI
ISTRI
02/07/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,736 0001601801818 1901010606930005
408
SUSANTO
ANAK
06/06/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,737 0001601801829 1901010506000003
408
SANTOSO
ANAK
05/06/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,738 0001601801831 1901012108510002
412
MAWI B. AHAD
PESERTA
21/08/1951
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,739 0001601801842 1901015704630003
412
SUMIATI
ISTRI
17/04/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,740 0001601801853 1901010706860005
412
MEGI SALASA
ANAK
07/06/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,741 0001601801864 1901011203110001
412
RAHMI AYATUL HUSNA
ANAK
12/03/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,742 0001601801875 1901013006480001
416
AMAT TOIB
PESERTA
30/06/1948
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,743 0001601801886 1901014607400002
416
MANIS
ISTRI
06/07/1940
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,744 0001601801897 1901010107680021
418
ROJIKIN ROY
PESERTA
01/07/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 76 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,745 0001601801908 1901014107650014
418
MARIAH
ISTRI
01/07/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,746 0001601801919 1901016112940001
418
MENTARI
ANAK
21/12/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,747 0001601801921 1901010107630013
421
KORNEN
PESERTA
01/07/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,748 0001601801932 1901014808780008
421
MARYADA
ISTRI
08/08/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,749 0001601801943 1901015607010003
421
GITA MARYANA
ANAK
16/07/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,750 0001601801954 1901011206630001
424
SUASRI HUSIN
PESERTA
01/07/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,751 0001601801965 1901014107710022
424
DAYANG
ISTRI
01/07/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,752 0001601801976 1901016704900002
424
SOFIA
ANAK
27/04/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,753 0001601801987 1901015802910001
424
YULIA
ANAK
18/02/1991
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,754 0001601801998 1901016804960001
424
SITI ASDARI
ANAK
28/04/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,755 0001601802009 1901014501020007
424
SAYUTI LESTARI
ANAK
05/01/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,756 0001601802011 1901014107720018
431
LIANA
PESERTA
01/07/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,757 0001601802022 1901010705760004
432
M. MUNIR
PESERTA
07/05/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,758 0001601802033 1901016009830003
432
SARIMA
ISTRI
20/09/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,759 0001601802044 1901011605020003
432
MOHAN HALIEM
ANAK
16/05/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,760 0001601802055 1901012001040003
432
DZUHRI ALFAREZA
ANAK
20/01/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,761 0001601802066 1901010502580004
436
SUKIRNO
PESERTA
05/02/1955
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,762 0001601802077 1901015004600004
436
MARTINA
ISTRI
10/04/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,763 0001601802088 1901011201900005
436
MARKAN SUPRAPTO
ANAK
12/01/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,764 0001601802099 1901010103000001
436
LATIF SUDIRMAN
ANAK
01/03/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,765 0001601802101 1901012503780004
440
KIAGUS ZULFIKAR
PESERTA
25/03/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,766 0001601802112 1901015711780001
440
NOVRI YANTI HARAHAP
ISTRI
17/11/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,767 0001601802123 1901011905040002
440
KIAGUS HABIBIE
ANAK
19/05/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 77 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,768 0001601802134 1901017108810002
444
SITI CAHAYA
PESERTA
31/08/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,769 0001601802145 1901011210000002
444
IVAN ANDREAN
ANAK
12/10/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,770 0001601802156 1901010107700034
446
SAHARI
PESERTA
01/07/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,771 0001601802167 1901014308690002
446
VIVIAN LOLASTY
ISTRI
03/06/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,772 0001601802178 1901011103930002
446
M. CHAIRUL AJYAL
ANAK
11/03/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,773 0001601802189 1901016505990002
446
SHERLY MERDIANA
ANAK
25/05/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,774 0001601802191 1901010504460002
450
DIRAH
PESERTA
05/04/1946
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,775 0001601802202 1901015410590002
451
KARSINA
PESERTA
14/10/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,776 0001601802213 1901011403830001
452
ROZI
PESERTA
14/03/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,777 0001601802224 1901014101830001
452
RUSMINI
ISTRI
01/01/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,778 0001601802235 1901015306070007
452
ZAHWA ZAYYITHA
ANAK
13/08/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,779 0001601802246 1901016802010003
452
TRISNA SUGITA
ANAK
28/02/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,780 0001601802257 1901014205070006
452
MYTHA SYSILIA
ANAK
02/05/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,781 0001601802268 1901014107680013
457
SOLEHA
PESERTA
01/07/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,782 0001601802279 1901012401990003
457
ZULKARNAIN
ANAK
24/01/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,783 0001601802281 1901017112430004
459
GIMAH
PESERTA
31/12/1943
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,784 0001601802292 1901012211860003
459
MEGO SUSILO
ANAK
22/11/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,785 0001601802303 1901015001740003
462
HAYUNA
PESERTA
01/10/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,786 0001601802314 1901011804950002
462
SENDI
ANAK
18/04/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,787 0001601802325 1901014703420001
464
TARMI
PESERTA
07/03/1942
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,788 0001601802336 1901012712550002
466
SUPARYAN M. SAID
PESERTA
27/12/1955
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,789 0001601802347 1901014109550004
466
ROSIDA
ISTRI
01/09/1955
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,790 0001601802358 1901011103560003
468
BUDI MAHMUDI
PESERTA
11/03/1956
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 78 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,791 0001601802369 1901016504650001
468
ROHIMAH
ISTRI
25/04/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,792 0001601802371 1901010107680029
470
JAMALUDIN
PESERTA
01/07/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,793 0001601802382 1901016802680003
470
ROSMINI
ISTRI
28/02/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,794 0001601802393 1901014905580002
472
NURSIAH
PESERTA
09/05/1958
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,795 0001601802404 1901015511600003
473
MARJUNA
PESERTA
15/11/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,796 0001601802415 1901015204530001
474
MAINI
PESERTA
12/04/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,797 0001601802426 1901011805860002
474
IZHARI
ANAK
18/05/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,798 0001601802437 1901015709400001
477
RAUYA
PESERTA
17/09/1940
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,799 0001601802448 1901011710640002
478
MUHAMMAD YUSUF
PESERTA
17/10/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,800 0001601802459 1901015109670003
478
SUSILAWATI
ISTRI
09/11/1967
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,801 0001601802461 1901011708930003
478
ALFIONEDA
ANAK
17/08/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,802 0001601802483 1901015107590002
487
ELYANA
PESERTA
11/07/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,803 0001601802494 1901012511860004
487
NODI HARIADI
ANAK
25/11/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,804 0001601802505 1901016305000006
487
GANA NURSAFINA
ANAK
23/05/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,805 0001601802516 1901010812420001
490
HUSIN ISO
PESERTA
08/12/1942
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,806 0001601802527 1901015604430001
490
AINI
ISTRI
16/04/1943
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,807 0001601802538 1901012511890002
490
HAZANOBI
ANAK
25/11/1989
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,808 0001601802549 1901010107880012
490
REBUDI
ANAK
01/07/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,809 0001601802551 1901014411500001
494
NURYANI
PESERTA
04/11/1950
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,810 0001601802562 1901012110300001
499
LIE TET FAT
PESERTA
21/10/1930
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,811 0001601802573 1901015208800006
500
SUSIATY
PESERTA
12/08/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,812 0001601802584 1901015603020001
500
SHEILA SIMBA PUTRI
ANAK
16/03/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,813 0001601802595 1901012703050001
500
FUK MING SIM KO PUTRA
ANAK
27/03/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 79 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,814 0001601802606 1901012308570003
503
LIE TJOE YOENG
PESERTA
23/08/1957
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,815 0001601802617 1901014203570002
503
ERI LIWAN
TAMBAHAN
02/03/1957
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,816 0001601802628 1901014210550002
505
MIMI SUMARNI
PESERTA
10/02/1955
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,817 0001601802639 1901014401570003
505
WILLIONNELI
ISTRI
01/04/1957
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,818 0001601802641 1901016109740003
508
KIM LIAN
PESERTA
21/09/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,819 0001601802652 1901014607980001
508
INDAH LAURENSIA
ISTRI
06/07/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,820 0001601802663 1901016603010004
508
CINTIA LAURENSIA
ANAK
26/03/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,821 0001601802674 1901015510530005
512
TJO MOI
PESERTA
15/10/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,822 0001601802685 1901016007530004
515
TJHIN MIE SIAN
PESERTA
20/07/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,823 0001601802696 1901012905470001
516
IBRAHIM
PESERTA
29/05/1947
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,824 0001601802707 1901014593540004
516
ROSNA
ISTRI
05/03/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,825 0001601802718 1901015303490001
518
HASLA
PESERTA
13/03/1949
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,826 0001601802729 1901014906660002
519
SRIWANI
PESERTA
09/06/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,827 0001601802731 1901015010590003
520
SURNAYATI
PESERTA
10/10/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,828 0001601802742 1901011505400001
521
DAHLAN
PESERTA
15/05/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,829 0001601802753 1901015207550002
521
SAHARA
ISTRI
12/07/1955
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,830 0001601802764 1901014907950001
521
SINTHYA DEWI
ANAK
09/07/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,831 0001601802775 1901016008630004
524
HANISA
PESERTA
20/08/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,832 0001601802786 1901011111960005
524
YOPI AVIANTO
ANAK
11/11/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,833 0001601802797 1901011305730002
526
HELMY SABRANTO
PESERTA
13/05/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,834 0001601802808 1901014707790003
526
SUKARSIH
ISTRI
07/06/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,835 0001601802819 1901015603010001
526
ADETIYAH LALA LATIFA
ANAK
16/03/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,836 0001601802821 1901010201060001
526
DWIKY ALFATUR ROZZY
ANAK
02/01/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 80 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,837 0001601802832 1901016004330001
530
HAMINA
PESERTA
20/04/1933
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,838 0001601802843 1901010701880017
531
FIRDIANSYAH
PESERTA
01/02/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,839 0001601802854 1901010108420005
532
ABU BAKAR YUNUS
PESERTA
01/08/1942
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,840 0001601802865 1901015208590001
533
ANNIZAR
PESERTA
12/08/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,841 0001601802876 1901015107710002
533
SAYUAM
ISTRI
11/07/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,842 0001601802887 1901011806680002
535
MULYADI
PESERTA
18/06/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,843 0001601802898 1901014711820002
535
SURYANI
ISTRI
07/11/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,844 0001601802909 1901010107000016
535
VEJITA AL FARIZI
ANAK
01/07/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,845 0001601802911 1901016808080002
535
VELITA ARUMI
ANAK
28/08/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,846 0001601802922 1671072510880008
535
USIN PRIANTO
TAMBAHAN
25/10/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,847 0001601802933 1901010104540004
540
SAKLI
PESERTA
01/04/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,848 0001601802944 1901017112540003
541
INDUN
PESERTA
31/12/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,849 0001601802955 1901016908950003
541
AGUSTINI
ANAK
29/08/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,850 0001601802966 1901010906450002
543
MARZUKI SAHARI
PESERTA
09/06/1945
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,851 0001601802977 1901017112550002
543
SUKAIDAH
TAMBAHAN
31/12/1955
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,852 0001601802988 1901012803640001
545
SUPERAN SANI
PESERTA
28/03/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,853 0001601802999 1901014609740002
545
YEYEN UMIYATI
ISTRI
06/09/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,854 0001601803001 1901011010070006
545
DEWANGGA
ANAK
10/10/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,855 0001601803012 1901014106770006
548
SUNARTI
PESERTA
01/05/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,856 0001601803023 1901012212940003
548
MUHAMMAD REYNALDO
ANAK
22/12/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,857 0001601803034 1901015405030006
548
ANANDA RESTU TIANI
ANAK
14/05/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,858 0001601803045 1901010707730005
551
YULIZAR
PESERTA
07/07/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,859 0001601803056 1901014805770005
551
MARIANA
ISTRI
08/05/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 81 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,860 0001601803067 1901012807960001
551
IMAM MAULANA
ANAK
28/07/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,861 0001601803078 1901010202030005
551
FIRMAN ADITYA PRANATA
ANAK
02/02/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,862 0001601803089 1901010710540002
555
IZWAR
PESERTA
07/10/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,863 0001601803091 1901016011620002
555
SARINA
ISTRI
20/11/1962
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,864 0001601803102 1901010506660003
559
SAIMI
PESERTA
05/06/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,865 0001601803113 1901017010720002
559
MARLINA
ISTRI
30/10/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,866 0001601803124 1901014208020008
559
TANAZALUL BAROKA
ANAK
02/08/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,867 0001601803135 1901010712590002
563
SARJULI
PESERTA
12/07/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,868 0001601803146 1901014701800006
564
SAINUR. S
PESERTA
07/01/1938
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,869 0001601803157 1901010701480005
565
ABDUL GANI MALIK
PESERTA
07/01/1948
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,870 0001601803168 1901014912520002
565
MAIMUN
ISTRI
09/12/1952
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,871 0001601803179 1901017103740004
565
ERMAYANTI
ANAK
31/03/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,872 0001601803181 1901014205790003
565
FILMAWATI
ANAK
02/05/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,873 0001601803192 1901016810590002
569
MULYANI
PESERTA
28/10/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,874 0001601803203 1901016704920007
569
WINDA AFRILIA
ANAK
27/04/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,875 0001601803214 1901014605720003
571
YURITA
PESERTA
06/05/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,876 0001601803225 1901011003060002
571
ASSYAFI FIKRI
ANAK
10/03/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,877 0001601803236 3175072303660012
573
EDI SUSILA
PESERTA
23/03/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,878 0001601803247 3175075010630023
573
SRI PUJAWATI
ISTRI
10/10/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,879 0001601803258 3175072108890005
573
RIAN GUSTIAWAN PUTRA
ANAK
21/08/1989
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,880 0001601803269 3175074601960002
573
RISMA AYU WARDINI
ANAK
06/01/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,881 0001601803271 3175072610980003
573
RAMA OKINAWA PUTRA
ANAK
26/10/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,882 0001601803282 1901016309620005
578
SAILANI
PESERTA
23/09/1962
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 82 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,883 0001601803293 1901013010900003
578
NORI ARDIANSYAH
ANAK
30/10/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,884 0001601803304 1901016006010001
578
YESSY ANGGREANI
ANAK
20/06/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,885 0001601803315 1901014305400001
581
SUAINI
PESERTA
03/05/1940
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,886 0001601803326 1901010809730003
582
EDY SURYONO
PESERTA
08/09/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,887 0001601803337 1901014504710001
582
UMI KHASANAH
ISTRI
05/04/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,888 0001601803348 1901014109440002
584
MAIDAH
PESERTA
01/09/1944
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,889 0001601803359 1901011503740003
584
JAMHUR
ANAK
15/03/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,890 0001601803361 1901017012520004
586
SURYA
PESERTA
02/12/1952
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,891 0001601803372 1901012708450003
587
A. HAMAD. HATOB
PESERTA
27/08/1949
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,892 0001601803383 1901015212500002
587
MAZNAH
ISTRI
12/12/1949
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,893 0001601803394 1901010203610001
589
KOMARRUDIN
PESERTA
02/03/1961
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,894 0001601803405 1901014107480013
590
HANIJUT
PESERTA
07/01/1952
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,895 0001601803416 1910104101550012
591
MAISUMI
PESERTA
01/01/1955
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,896 0001601803427 1901014701320007
592
NAHYA
PESERTA
07/07/1932
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,897 0001601803438 1901011003690002
592
DARNOYO
ANAK
03/10/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,898 0001601803449 1901010803020003
592
NURMANSYAH
ANAK
03/08/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,899 0001601803451 1901010206620001
595
SURYADI MUIN
PESERTA
02/06/1962
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,900 0001601803462 1901017012620003
595
AMALIA
ISTRI
30/12/1962
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,901 0001601803473 1901010703870002
595
HARRI
ANAK
07/03/1987
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,902 0001601803484 1901010701600005
598
BAHARI
PESERTA
07/01/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,903 0001601803495 1901014701640007
598
ARPAH
ISTRI
07/01/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,904 0001601803506 1901012312930002
598
BIRZAH
ANAK
23/12/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,905 0001601803517 1901013012630002
601
ARSON
PESERTA
30/12/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 83 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,906 0001601803528 1901015109840005
601
ELVANIA
ISTRI
11/04/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,907 0001601803539 1901017102050001
601
RISKI SHAVINA
ANAK
31/03/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,908 0001601803541 1901014410020006
604
SUVIARNA AKHIRANI
PESERTA
04/10/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,909 0001601803552 1901016803760002
608
HASLINDA
PESERTA
28/03/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,910 0001601803563 1901010111760003
609
TONI SUNARTA
PESERTA
01/11/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,911 0001601803574 1901016207080001
609
JOANA KASIH
ANAK
22/07/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,912 0001601803585 1901010906100002
609
DIMITRI FITO FAZAN IBRAHIM
ANAK
09/06/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,913 0001601803596 1901015907770008
613
YULIANA
PESERTA
19/07/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,914 0001601803607 1901010509810003
617
EDISON
PESERTA
05/07/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,915 0001601803618 1901016108790003
620
MARPUAH
PESERTA
13/08/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,916 0001601803629 1901013002930003
622
SITI NURAINI
PESERTA
19/02/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,917 0001601803631 1901011810470001
623
BAKRI
PESERTA
18/10/1947
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,918 0001601803642 1901015407500004
623
SURIANI
ISTRI
14/07/1950
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,919 0001601803653 1901011006510001
626
LIOE A HAW
PESERTA
10/06/1951
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,920 0001601803664 1901016010610004
626
TJHAI MIE YUN
ISTRI
10/11/1962
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,921 0001601803675 1901012810760001
628
THEN NGIT HIUNG
PESERTA
28/10/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,922 0001601803686 1901016912770003
628
YUTI HARNINGSIH
ISTRI
29/12/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,923 0001601803697 1901012404000009
628
KEVIN SIN CINGLUNG

DERMAWAN
ANAK
24/04/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,924 0001601803708 1901015608080003
628
KEISYA YAULIEN DERMAWAN ANAK
16/08/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,925 0001601803719 1901011503450001
632
BUN BUN FO
PESERTA
15/03/1945
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,926 0001601803721 1901017112460003
632
BONG KAP LU
ISTRI
31/12/1946
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,927 0001601803732 1901011302790005
634
NGIT KHIONG
PESERTA
13/02/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,928 0001601803743 1901016606840003
634
MELIA
ISTRI
26/06/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 84 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,929 0001601803754 1901012010040004
634
JASSEN FERNANDO, SIN
ANAK
20/10/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,930 0001601803765 1901010904130001
634
YOEL APRILLO, SIN
ANAK
09/04/2013
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,931 0001601803776 1901011704370003
638
LIU DJAT LOI
PESERTA
17/04/1937
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,932 0001601803787 1901010701800012
639
ADIN
PESERTA
01/07/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,933 0001601803798 1971025006790003
639
ELIES
ISTRI
10/06/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,934 0001601803809 1901016410120001
639
SRI MULYANI INDRAWATI
ANAK
24/10/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,935 0001601803811 1901011510270001
642
LIEM KON FOEI
PESERTA
15/10/1927
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,936 0001601803822 1901016802640001
643
AIRA BARITO
PESERTA
28/02/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,937 0001601803833 1901011406570001
644
ISMANTO
PESERTA
14/06/1957
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,938 0001601803844 1901014306560003
645
FOE SOEI NON
PESERTA
06/03/1956
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,939 0001601803855 1901015101530002
646
BONG DJUN KIAN
PESERTA
11/01/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,940 0001601803866 1901010506750004
648
JUN FUI
PESERTA
05/08/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,941 0001601803877 1901012410570002
649
BUI MOK LOI
PESERTA
24/10/1957
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,942 0001601803888 1901016703590001
650
SIN TJIANG
PESERTA
27/03/1958
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,943 0001601803899 1901012802940003
650
HENDRA
ANAK
29/01/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,944 0001601803901 1901016904980002
650
NOVIYANTI
ANAK
29/11/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,945 0001601803912 1901011312660002
653
KWET KHO
PESERTA
13/12/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,946 0001601803923 1901016210480001
653
TJIOE KIE SIAN
ISTRI
22/10/1948
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,947 0001601803934 1901011309610006
655
TJIOE HIAN PIN
PESERTA
13/09/1961
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,948 0001601803945 1901011909520001
656
DJOEN FO
PESERTA
19/09/1952
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,949 0001601803956 1901016508370001
657
LIE KON LIE
PESERTA
25/08/1937
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,950 0001601803967 1901012805690001
659
EDDY
PESERTA
28/05/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,951 0001601803978 1901010510330001
660
BONG PIT FONG
PESERTA
05/10/1933
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 85 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,952 0001601803989 1901015501660002
660
LIE SIOE JIN
ISTRI
15/01/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,953 0001601803991 1901016008990004
660
LUCIANA CHRISTINE
ANAK
20/08/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,954 0001601804002 1901015610020003
660
DESIANA
ANAK
16/10/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,955 0001601804035 1901015509980006
666
SANTI
PESERTA
15/09/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,956 0001601804046 1901013001600001
667
TJONG DJUN KWET
PESERTA
30/01/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,957 0001601804057 1901016506650002
667
LIE A TJHIN
ISTRI
25/06/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,958 0001601804068 1901014110940002
667
ALIU
ANAK
01/10/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,959 0001601804079 1901012109040007
667
PAUMIN DJAUHARI
ANAK
21/09/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,960 0001601804103 1901010711540003
673
EDDY
PESERTA
07/11/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,961 0001601804114 1901016805590001
673
LIE NGIE NJONG
ISTRI
28/05/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,962 0001601804125 1901012304930002
673
MARDIONO
ANAK
23/04/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,963 0001601804147 1901011002740002
677
TJAW SING
PESERTA
10/02/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,964 0001601804158 1901012202990001
677
SAMUEL ANDRIE SAPUTRA
ANAK
22/02/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,965 0001601804169 1901017101110001
679
NOVELITA CHERLYA
PESERTA
31/01/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,966 0001601804171 1901012610850002
680
ANTONI
PESERTA
26/10/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,967 0001601804182 1901016106850002
680
JUNIAWATI
ISTRI
21/06/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,968 0001601804193 1901015609030003
680
NATALIA
ANAK
16/09/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,969 0001601804204 1901011311080003
680
KELVIN MARCELINO
ANAK
13/11/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,970 0001601804215 1901016708130001
680
CAROLINE LAURENSIA
ANAK
07/08/2013
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,971 0001601804226 1901014202500001
685
DJONG SUI CAM
PESERTA
02/02/1950
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,972 0001601804237 1901015902530001
686
LIE MUK HIONG
PESERTA
19/02/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,973 0001601804248 1901016601270001
686
LIM A MIE
ISTRI
26/01/1927
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,974 0001601804259 1901011810860002
688
MELEN OKTAVIA
PESERTA
18/10/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 86 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,975 0001601804261 1901012008870008
688
ALBERT AGUSTINUS
ISTRI
20/08/1987
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,976 0001601804272 1901010910000003
688
STANLEY JOVALDI
ANAK
09/10/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,977 0001601804283 1901011211770003
691
SIONG MIN
PESERTA
12/11/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,978 0001601804294 1901017010810002
691
AMELIA ENSELINA
ISTRI
30/10/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,979 0001601804305 1901015807100003
691
JULIA CHRISTIANY
ANAK
18/07/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,980 0001601804316 1901010607850004
694
MUSLIMIN
PESERTA
06/07/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,981 0001601804327 1901014312970004
695
SRI MARYANI
PESERTA
02/12/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,982 0001601804338 1901010805590001
696
TJHIN SUI PHIN
PESERTA
03/08/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,983 0001601804349 1901015611610002
696
LIOE MIE TJIN
ISTRI
16/11/1961
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,984 0001601804351 1901011407810009
699
TUMIN
PESERTA
14/07/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,985 0001601804362 1901014503900001
699
SRI WAHYUNI
ANAK
05/03/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,986 0001601804373 1901011306100002
699
APRIANTO
ANAK
13/06/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,987 0001601804384 1901014407880002
704
LO NJOEN JIN
PESERTA
04/07/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,988 0001601804395 1901014912030003
704
SONIA LORENSIA
ANAK
11/01/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,989 0001601804406 1901010909640002
706
TJEN KONG FOEK
PESERTA
09/09/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,990 0001601804417 1901015102710003
706
THEN LIE JIN
ISTRI
11/02/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,991 0001601804428 1901010810700002
710
IVAN LAI
PESERTA
11/08/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,992 0001601804439 1901015103770003
710
PIT JIN
ISTRI
11/03/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,993 0001601804441 1901012202640003
710
TJONG NAM HIAN
TAMBAHAN
22/02/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,994 0001601804452 1901014312380002
713
TJHIE A KIAM
PESERTA
03/12/1938
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,995 0001601804463 1901010611460001
715
THONG KHIN LOY
PESERTA
11/06/1946
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,996 0001601804474 1901015102530001
715
HIOE LOEN CIN
ISTRI
25/08/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,997 0001601804485 1901010804840002
715
MARTIN CANDRA
ANAK
04/08/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 87 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
1,998 0001601804496 1901010802550003
722
DJAP NAM FON
PESERTA
08/02/1955
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
1,999 0001601804507 1901015109580004
722
TJONG KIM LIAN
ISTRI
11/09/1958
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,000 0001601804518 1901010711510006
724
TJHIN THAT SAN
PESERTA
28/02/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,001 0001601804529 1901012005860003
726
HENDRAH
PESERTA
20/03/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,002 0001601804531 1901015604880003
726
FITRI MULYANI
ISTRI
16/04/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,003 0001601804542 1901016701100002
726
BELLA ENZELIA
ANAK
27/01/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,004 0001601804553 1901010303490001
731
RUSLI LIMARTI
PESERTA
03/03/1949
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,005 0001601804564 1901014301470002
731
ASTINA NURSALIM
ISTRI
03/01/1947
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,006 0001601804575 1901011806830003
733
YONO
PESERTA
18/06/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,007 0001601804586 1901016205840003
733
DARYATI
ISTRI
22/05/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,008 0001601804597 1901016408070001
733
YOANDA GRESELLA
ANAK
24/08/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,009 0001601804608 1901010809090002
733
STEVEN JAVIER NIXON
ANAK
08/09/2009
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,010 0001601804619 1901010605800010
740
HAN SIONG
PESERTA
06/05/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,011 0001601804621 1901012511540004
741
KON PIT MEN
PESERTA
25/11/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,012 0001601804632 1901011612770003
742
SUN LIONG
PESERTA
16/12/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,013 0001601804643 1901014802810005
742
AYU
ISTRI
08/02/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,014 0001601804665 1901010304510004
756
MEN KHIAN
PESERTA
03/04/1951
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,015 0001601804676 3309034112600014
757
SUKI
PESERTA
01/12/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,016 0001601804687 3309031301950002
757
SLAMET
ANAK
13/01/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,017 0001601804698 1901016509450003
759
NEN A KIM
PESERTA
25/09/1945
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,018 0001601804709 1901014302730002
759
MUK ING
ISTRI
03/02/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,019 0001601804711 1901012011690002
761
EDDY LOMAX
PESERTA
20/11/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,020 0001601804722 1901017010760001
761
SUI ING
ISTRI
30/11/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 88 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,021 0001601804733 1901012212890002
763
YUNG PI
PESERTA
22/12/1989
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,022 0001601804744 1901051804920002
763
FENNY KARTIKA DEWI
ANAK
18/02/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,023 0001601804755 1901015706130003
763
LETIZA EARLENE JECONIA
ANAK
17/08/2013
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,024 0001601804766 1901011704720002
766
KARMAN
PESERTA
17/04/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,025 0001601804777 1901014303740003
766
SULIYEM
ISTRI
03/03/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,026 0001601804788 1901010402960001
766
EKO SUNARWAN
ANAK
04/02/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,027 0001601804799 1901015411010004
766
PURNIAWATI
ANAK
14/11/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,028 0001601804801 1901015411010005
766
PURNIASARI
ANAK
14/11/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,029 0001601804812 1901015404090003
766
ANI SUPRAPTI
ANAK
14/04/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,030 0001601804823 1901011807790004
772
DWI SUGIARTO
PESERTA
18/07/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,031 0001601804834 1901016509820003
772
SENI
ISTRI
25/09/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,032 0001601804845 1901014109030003
772
TRIYANI PUTRI SEPTIKA
ANAK
01/09/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,033 0001601804856 1901010611090000
772
ISMAIL PUTRA ALFARIDZY
ANAK
06/11/2009
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,034 0001601804867 3309011001790001
776
MARDIANTO
PESERTA
10/01/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,035 0001601804878 3309015001810001
776
TUMIRA
ISTRI
10/01/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,036 0001601804889 3309011004020004
776
SUPREHANTO
ANAK
10/04/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,037 0001601804891 3309012307090001
776
RADIKA GILAR PATIYO
ANAK
23/07/2009
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,038 0001601804902 1901015006530004
780
JUNA
PESERTA
01/10/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,039 0001601804913 1901011010770001
781
DARSI
PESERTA
10/10/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,040 0001601804924 1901014602800005
781
LENA
ISTRI
02/06/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,041 0001601804935 1901010705000009
781
AHMAD FAUZI
ANAK
05/07/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,042 0001601804946 1901014701060008
781
ARINI SITI FAUZYAH
ANAK
01/07/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,043 0001601804957 1901014701360005
781
DARMA
TAMBAHAN
07/01/1936
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 89 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,044 0001601804968 1901014107390008
786
PUTIK
PESERTA
01/07/1939
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,045 0001601804979 1901010301740004
787
SURYADI
PESERTA
03/01/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,046 0001601804981 1901014611800003
787
SOLBIAH
ISTRI
06/11/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,047 0001601804992 1901012502030004
787
AHMAD AZIZA ASSALAM
ANAK
25/02/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,048 0001601805003 1901016803080001
787
INDASYA PUTRI
ANAK
28/03/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,049 0001601805014 1901011003360001
791
SEMAT ISO
PESERTA
10/03/1936
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,050 0001601805025 1901016409530002
791
ROAINI
ISTRI
24/09/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,051 0001601805036 1901010408990004
791
ARWANTO
ANAK
04/08/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,052 0001601805047 1901012811760003
794
ZULKARNAEN
PESERTA
28/11/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,053 0001601805058 1901014304820003
794
DARYATI
ISTRI
03/04/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,054 0001601805069 1901010609040002
794
IBNU SABIL
ANAK
08/09/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,055 0001601805071 1901012007080003
794
IQBAL FAHBIL
ANAK
20/07/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,056 0001601805082 1901010101630002
798
MUNASIK
PESERTA
01/01/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,057 0001601805093 1901016311590003
798
DINA
ISTRI
23/11/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,058 0001601805104 1901014112880004
798
MEGA MUSTIKA
ANAK
12/01/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,059 0001601805115 1901016509930001
798
MELISA
ANAK
25/09/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,060 0001601805126 1901010402470002
798
HARIP
ANAK
04/02/1947
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,061 0001601805172 1901012501650002
807
SUHERMEN
PESERTA
25/01/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,062 0001601805183 1901015706720001
807
BETTI ROHMA
ISTRI
17/06/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,063 0001601805194 1901013001960006
807
SYAHRUL RIZKI MUBHAROK
ANAK
30/01/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,064 0001601805205 1901016511980001
807
NABILA ISMI ROSALINA
ANAK
25/02/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,065 0001601805216 1901016203030002
807
ADINA FADILLAH BALQIS
ANAK
22/03/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,066 0001601805227 1901015702580003
812
RUSMIYATI
PESERTA
17/02/1958
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 90 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,067 0001601805238 1901016803950002
812
KURNIAWATI
ANAK
22/02/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,068 0001601805249 1901072308860008
814
KURNIAWAN
PESERTA
23/08/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,069 0001601805251 1901014704880010
814
NURUL PUTRI UTAMI
ISTRI
07/04/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,070 0001601805262 1901015306060010
814
RISDA FAJRINA DINANTI
ANAK
13/06/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,071 0001601805273 1901076607120002
814
ZAHIRA RAMADHANI
ANAK
26/07/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,072 0001601805284 1901010707690003
818
ANDOYO
PESERTA
07/07/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,073 0001601805295 1901014108750002
818
MISNA
ISTRI
01/08/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,074 0001601805306 1901010911990003
818
RESTU
ANAK
09/11/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,075 0001601805317 1901016011050002
818
HANUM KARTIKA
ANAK
20/11/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,076 0001601805328 1901011506680002
825
RONEFFENDRI
PESERTA
15/06/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,077 0001601805339 1901014401710001
825
ZAITUN
ISTRI
04/01/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,078 0001601805341 1901010108630003
827
SOLEH
PESERTA
01/08/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,079 0001601805352 1901015907650001
827
JUMILAWATI
ISTRI
19/07/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,080 0001601805363 1901014805590002
829
AMNAH
PESERTA
08/05/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,081 0001601805374 1901011510920002
829
RAPIANTO
ANAK
15/10/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,082 0001601805385 1901012807820004
831
YURIZAL ARDIANSYAH
PESERTA
28/07/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,083 0001601805396 1901015309830002
831
SRI HARMINI
ISTRI
13/09/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,084 0001601805407 1901011309070002
831
RISKY RAMADHAN
ANAK
13/09/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,085 0001601805418 1901016503140000
831
RIZA AULIA
ANAK
25/03/2014
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,086 0001601805429 1901011911600001
835
SRI BATARA WISNU
PESERTA
19/11/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,087 0001601805431 1901014201580001
835
FOENG POSA
ISTRI
02/01/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,088 0001601805442 1901012407850003
835
FESTI DEVISERANTIAN
ANAK
24/07/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,089 0001601805453 1901012803870001
835
ARI MAULANA NUGRAHA
ANAK
28/03/1987
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 91 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,090 0001601805464 1901011203090003
835
AXEL BERNARD FIESPA
ANAK
12/03/2009
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,091 0001601805475 1901010101900001
840
ADE CHISTIAN MALTA
PESERTA
01/01/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,092 0001601805486 1901024112860003
840
SOLEHATI
ISTRI
01/12/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,093 0001601805497 1901016603130002
840
BIANCA CAFFARA
ANAK
26/03/2013
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,094 0001601805508 1901015407630002
844
NONI
PESERTA
14/07/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,095 0001601805519 1901010602860002
844
HARIANTO
ANAK
06/02/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,096 0001601805521 1901012205940001
844
MEIDIANTO
ANAK
22/05/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,097 0001601805532 1901016807950002
844
MELIANTI
ANAK
06/07/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,098 0001601805543 1901011405670003
848
ADDAMI
PESERTA
14/05/1967
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,099 0001601805554 1901014102720001
848
ENI SUKANDAR
ISTRI
01/02/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,100 0001601805565 1901010607940001
848
ALPIAN PONI
ANAK
06/07/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,101 0001601805576 1901016606990001
848
VIVI VONNY
ANAK
26/06/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,102 0001601805587 1901016109020001
848
WULAN VONI
ANAK
21/09/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,103 0001601805598 1901012502840002
853
PINARTO
PESERTA
25/02/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,104 0001601805609 1901014405850006
853
ICE ICIANA
ISTRI
04/05/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,105 0001601805611 1901014407050002
853
ANGELITA STEFANIE PUTRI
ANAK
04/07/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,106 0001601805622 1901012401110001
853
JUSTYN DAVEFANNO
ANAK
24/01/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,107 0001601805633 1901012802530001
857
TJHONG KIUN TJUN
PESERTA
28/02/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,108 0001601805644 1901015605580002
857
TJHIE TJIT SIAN
ISTRI
16/05/1958
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,109 0001601805655 1901010911920006
862
JANTO
PESERTA
09/11/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,110 0001601805666 1901012802580002
863
HENDRI MULYONO
PESERTA
28/02/1958
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,111 0001601805677 1901015002560004
863
NIE YIN
ISTRI
10/02/1958
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,112 0001601805688 3209252409660004
865
WARGI
PESERTA
24/09/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 92 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,113 0001601805699 3209255902730008
865
ROMLA
ISTRI
19/02/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,114 0001601805701 3209256009040003
865
KUSNA
ANAK
20/09/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,115 0001601805712 1901015110790004
868
MIMI MARYANI
PESERTA
11/10/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,116 0001601805723 1901016204040002
868
SITI FATIMAH PUTRI
ANAK
22/04/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,117 0001601805734 1901011105720001
870
INDRATNO
PESERTA
11/05/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,118 0001601805745 1901010701820022
871
G. A MASKURI
PESERTA
01/01/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,119 0001601805756 1901016307700001
872
KARTINI
PESERTA
23/07/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,120 0001601805767 1901014110950002
872
VANIA OKTIANI PARIYAN
ANAK
01/10/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,121 0001601805778 1901010605970001
872
FERDY PARIYAN
TAMBAHAN
05/06/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,122 0001601805789 1901011003660001
875
BONG MUK HIN
PESERTA
10/03/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,123 0001601805791 1901015607680002
875
TINA
ISTRI
16/07/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,124 0001601805802 1901013003920001
875
MARYUDI
ANAK
30/03/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,125 0001601805813 1901014604940007
875
APRIYULIANI
ANAK
06/04/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,126 0001601805824 1901015912970002
875
DEWI MARTIN
ANAK
19/12/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,127 0001601805835 1901012903520003
880
TJHIN MUK LOIJ
PESERTA
29/03/1952
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,128 0001601805846 1901015106590001
880
FOENG MIE TJIT
ISTRI
11/06/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,129 0001601805857 1901016002810002
880
SIN SIN
ANAK
20/02/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,130 0001601805868 1901015007820005
880
SANTI
ANAK
10/07/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,131 0001601805879 1901012610840004
880
ANDRIE
ANAK
26/10/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,132 0001601805881 1901016508870004
880
ERMAH
ANAK
25/05/1987
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,133 0001601805892 1901011607920001
880
RIZAL
ANAK
16/07/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,134 0001601805903 1901011306840006
887
JUNAIDY, ST
PESERTA
13/06/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,135 0001601805914 1901014710810007
887
OKTAVIA HARTANTO
ISTRI
07/10/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 93 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,136 0001601805925 1901012809130002
887
SACHIO RICO WONGTOMO
ANAK
28/09/2013
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,137 0001601805936 1901013004790005
890
EFENDI
PESERTA
30/04/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,138 0001601805947 1901014606810003
890
SUI CEN
ISTRI
06/06/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,139 0001601805958 1901012608020001
890
RIZKI ARDIANSYAH
ANAK
26/08/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,140 0001601805969 1901012104110006
890
ADITYA MANDALA UTOMO
ANAK
21/04/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,141 0001601805971 1901016509130001
890
REGINA MEGA PRATIWI
ANAK
25/09/2013
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,142 0001601805982 1901011502620003
898
HO TJAUW DJAM
PESERTA
15/02/1962
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,143 0001601805993 1901014906900003
898
YUNITA. S
ANAK
09/06/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,144 0001601806004 1901011311920004
898
NOVENDI CANDRA
ANAK
13/11/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,145 0001601806015 1901011712630003
902
HERMANSYA
PESERTA
17/12/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,146 0001601806026 1901015009680005
902
SAINAH
TAMBAHAN
10/09/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,147 0001601806037 1901011105660002
904
MUHAZIR
PESERTA
11/05/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,148 0001601806048 1901013108810008
906
Ferdi
PESERTA
31/08/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,149 0001601806059 1901015907860005
906
Eka Yuliana
ISTRI
19/07/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,150 0001601806061 1901012602620006
910
BASTARI BASRAN
PESERTA
26/02/1962
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,151 0001601806072 1901016304670004
910
SUBAIDAH
ISTRI
23/04/1967
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,152 0001601806083 1901012308950005
910
MUHAMMAD NAWAWI
ANAK
23/08/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,153 0001601806094 1901010410600009
919
TJONG DJOEN PO
PESERTA
04/10/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,154 0001601806105 1901014901750004
919
PARAMITA LIENARTI LIE
ISTRI
09/01/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,155 0001601806116 1901011208820005
924
MARDIANTO
PESERTA
12/08/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,156 0001601806127 1901014601860002
924
RADO
ISTRI
06/01/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,157 0001601806138 1901010808690001
926
SUTIONO
PESERTA
08/08/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,158 0001601806149 1901014409690001
926
ROSMALA SARI
ISTRI
04/09/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 94 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,159 0001601806151 1901012504910002
926
ANGGA AFRIANSYAH
ANAK
25/04/1991
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,160 0001601806162 1901010111960001
926
ERI NOVIANSYAH
ANAK
01/11/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,161 0001601806173 1901011003080001
926
FAZILAH HABILLAMSYAH
ANAK
10/03/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,162 0001601806184 1602040810790001
931
SUGENG
PESERTA
13/10/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,163 0001601806195 1601015000484009
931
LINA
ISTRI
20/04/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,164 0001601806206 1871020909900015
935
MISWANTO
PESERTA
09/09/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,165 0001601806217 1901016307930004
935
MUHAYANAH
ISTRI
23/07/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,166 0001601806228 1871026606100002
935
SITI AL MUNAWAROH
ANAK
26/06/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,167 0001601806239 1901012008820005
935
MANSUR
TAMBAHAN
20/08/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,168 0001601806241 1901010101900007
935
ANDRE
TAMBAHAN
01/01/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,169 0001601806252 1901012210750001
940
LIU SIN KHIONG
PESERTA
22/10/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,170 0001601806263 1901011309000002
940
JEUFANA SEPTIAN PURNAMA ANAK
13/09/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,171 0001601806274 1901018605030001
940
WINFIANA MEILANA
BRIANTAMA
ANAK
28/05/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,172 0001601806285 1901014206080001
940
LOVANYA DEVIANA YUNITA
ANAK
02/06/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,173 0001601806296 1901017007640012
946
LIAN LIAN
PESERTA
30/07/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,174 0001601806307 1901013110940003
946
RENDI SUHANDRI
ANAK
31/10/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,175 0001601806318 1901014712950001
946
DESY OKTAVIANTI
ANAK
07/12/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,176 0001601806329 1901011704970005
946
BERRY SETIAWAN
ANAK
17/04/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,177 0001601806331 1901014206510002
950
LIE TJO HAM
PESERTA
02/06/1951
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,178 0001601806342 1901011809690003
951
TJHANG A LOY
PESERTA
18/09/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,179 0001601806353 1901015508680010
951
TJONG NYOEK LING
ISTRI
15/08/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,180 0001601806364 1901016812000002
951
SELLA SHELLVIANTI
ANAK
28/12/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,181 0001601806375 1901014501110001
951
GAvRIELLA
ANAK
05/01/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 95 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,182 0001601806386 1901013112750001
955
LALU MUHLIS
PESERTA
31/12/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,183 0001601806397 1901014101800007
955
RINA YULITA
ISTRI
01/01/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,184 0001601806408 1901014403110002
955
ABEL KHAIRUN NISA
ANAK
04/03/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,185 0001601806419 1901016010130001
955
KARISA SALSABILA
ANAK
20/10/2013
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,186 0001601806421 1901010506580006
959
ZAKARIA
PESERTA
05/06/1958
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,187 0001601806432 1901015808900009
959
AGUSTINA
ISTRI
18/08/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,188 0001601806443 1901015405070005
959
SEPTIANI
ANAK
14/05/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,189 0001601806454 1901015504110005
959
SUSANTI
ANAK
15/04/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,190 0001601806465 1901013006520002
963
KOESNADI
PESERTA
30/06/1952
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,191 0001601806476 1901017005520002
963
SITI MARIAM
ISTRI
30/05/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,192 0001601806487 1901011605610002
965
BAMBANG SUPOKO
PESERTA
16/05/1961
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,193 0001601806498 1901015804750002
965
ERA
ISTRI
18/04/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,194 0001601806509 1901010708990005
965
WALLY ANGGARA
ANAK
07/08/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,195 0001601806511 1901012706080002
965
REZKY JAYA SAPUTRA
ANAK
27/06/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,196 0001601806522 3311050502550002
969
SUBANDI
PESERTA
05/02/1955
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,197 0001601806533 3311054908730001
969
ENI NURAENI
ISTRI
09/08/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,198 0001601806544 3311051804990002
969
JEJE HURAJI
ANAK
18/04/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,199 0001601806555 3311056808020001
969
DEWI DWI WULANDARI
ANAK
28/08/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,200 0001601806566 3311052307060002
969
ANDIKA YULIANTO
ANAK
23/07/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,201 0001601806577 1901012812700005
974
SATRIO GONDO PRAMONO
PESERTA
28/12/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,202 0001601806588 1901016312740012
974
DEWI
ISTRI
23/12/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,203 0001601806599 1901013107010003
974
RIZKY DWI CAHYANA
ANAK
31/07/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,204 0001601806601 1901016610070003
974
FITRI TRIHARTANTI
ANAK
25/10/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 96 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,205 0001601806612 1901011203500004
978
LIM KIN PHIN
PESERTA
12/03/1950
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,206 0001601806623 1901015904590004
978
LIE A TJOEN
ISTRI
19/04/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,207 0001601806634 1901010608690002
980
HANAFIAH
PESERTA
06/08/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,208 0001601806645 1901014302790001
980
NEMI
ISTRI
03/02/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,209 0001601806656 1901015112910002
980
YANTI
ANAK
11/12/1991
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,210 0001601806667 1901014805990009
980
RERE MAHARANI
ANAK
08/05/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,211 0001601806678 1901011007100002
980
REYHAN MYRAHJ
ANAK
10/07/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,212 0001601806689 1901010408850005
985
IMAM IKHSAN QURBANI
PESERTA
04/08/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,213 0001601806691 1901016307880009
985
RASITA
ISTRI
23/07/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,214 0001601806702 1901010801090003
985
IKHSAN RAMAZHAN
ANAK
08/01/2009
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,215 0001601806713 1901012805130003
985
FAIZAN ABYAZ
ANAK
28/05/2013
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,216 0001601806724 1901014512670003
990
SUKMAWIDIA
PESERTA
05/12/1967
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,217 0001601806735 1901010608730002
993
YUSRIZAL
PESERTA
06/08/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,218 0001601806746 1901014907800004
993
AISYAH
ISTRI
09/07/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,219 0001601806757 1901010202040004
993
FAQIH AL QHASSAN
ANAK
02/02/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,220 0001601806768 1901010511080004
993
FATUR AL FARIZZY
ANAK
05/11/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,221 0001601806779 1905051104910002
1002
ROBI
PESERTA
11/04/1991
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,222 0001601806781 1901014101840011
1002
RADEN TRIMULYANI
ISTRI
01/01/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,223 0001601806792 1901016204050003
1002
MAULIDIA
ANAK
22/04/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,224 0001601806803 1901012609690002
1005
BAMBANG
PESERTA
26/09/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,225 0001601806814 1901014506750003
1005
SAMI
ISTRI
10/06/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,226 0001601806825 1901012402940005
1005
HABIB PRAYOGI
ANAK
24/02/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,227 0001601806836 1901011006030002
1005
IBNU NUR MISBAH
ANAK
10/06/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 97 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,228 0001601806847 1901012404700002
1009
YOHANES
PESERTA
24/04/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,229 0001601806858 1901017006650006
1009
HARYANTI
ISTRI
30/06/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,230 0001601806869 1901015309960006
1009
LELI SARI YOLANDA
ANAK
13/09/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,231 0001601806871 1901011006980005
1009
SATRIA KUMBARA
ANAK
10/06/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,232 0001601806882 1901015006980005
1009
SABELLA KUMBARI
ANAK
10/06/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,233 0001601806893 1901012709580002
1015
IDHAR HASYIM
PESERTA
27/09/1958
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,234 0001601806904 1901016308640004
1015
ZAITI ROBAIN
ISTRI
23/08/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,235 0001601806915 1901012601910007
1015
IRLAN
ANAK
26/01/1991
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
2,236 0001601806926 1901011201510002
3250
LA APA
PESERTA
12/01/1951
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,237 0001601806937 1901015910600003
3250
MARIANI
ISTRI
19/10/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,238 0001601806948 1901010612850004
3250
JUMAAH
ANAK
12/06/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,239 0001601806959 1901012601920002
3250
ALIMANSYAH
ANAK
26/01/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,240 0001601806961 1901014904700003
3254
SOPIAH
PESERTA
04/09/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,241 0001601806972 1901014910030001
3254
NIA FERISKA
ANAK
10/09/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,242 0001601806983 1901016008050001
3254
ANDI WINDA NOVISHA
ANAK
20/08/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,243 0001601806994 1901010706760001
3263
Romlah
PESERTA
04/03/1944
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,244 0001601807005 1901014304440001
3263
F.Pratiwi
ANAK
27/07/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,245 0001601807016 1901016707670006
3265
Amri Ranjanah
PESERTA
20/10/1983
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,246 0001601807027 1901012010830006
3265
Lilis
ISTRI
06/12/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,247 0001601807038 1901015206720001
3265
Damar Julia Alamsah
ANAK
08/10/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,248 0001601807049 1901011008970003
3265
Anggi Wanara
ANAK
27/02/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,249 0001601807051 1901016702070005
3269
Aceng
PESERTA
24/07/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,250 0001601807062 1901012407850004
3269
Suharsih
ISTRI
15/04/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 98 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,251 0001601807073 1901015504750001
3269
Arlita Mutiara Putri
ANAK
21/11/2010
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,252 0001601807084 1901016111100002
3272
Irzami
PESERTA
10/10/1952
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,253 0001601807095 1901011010730004
3274
Ali Sastra
PESERTA
10/10/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,254 0001601807106 1901015502720004
3274
Arina
ISTRI
15/02/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,255 0001601807117 1901011902090001
3274
Ariyanto
ANAK
19/02/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,256 0001601807128 1901013008320003
3280
Djie Kong Tjong
PESERTA
30/08/1932
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,257 0001601807139 1901016308700001
3281
Surinah
PESERTA
23/08/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,258 0001601807141 1901016711010001
3281
Erida Wati
ANAK
27/11/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,259 0001601807152 1901012404690002
3286
Jen Min
PESERTA
24/04/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,260 0001601807163 1901014511700003
3286
Mie Lie
ISTRI
11/05/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,261 0001601807174 1901012204010001
3286
Dandi Efendi
ANAK
22/04/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,262 0001601807185 1901012702030001
3286
Heriyanto
ANAK
27/02/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,263 0001601807196 1901016108700002
3290
Tjen Tjo Li
PESERTA
21/08/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,264 0001601807207 1901011312970002
3290
Dohan Lusiana
ANAK
13/12/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,265 0001601807218 1901012912010001
3290
Fendi
ANAK
29/12/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,266 0001601807229 1901012807830001
3296
Midiyanto
PESERTA
28/07/1983
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,267 0001601807231 1901011007660002
3298
We Lie
PESERTA
07/10/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,268 0001601807242 1901011409550001
3300
Bong A Hiung
PESERTA
14/09/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,269 0001601807253 1901015103610001
3300
Lie Nyuk Tjang
ISTRI
03/11/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,270 0001601807264 1901012903850001
3300
Lie Sui Ming
ANAK
29/03/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,271 0001601807275 1901014701540018
3304
Mimi Ida
PESERTA
01/07/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,272 0001601807286 1901011905820001
3304
Johan
ANAK
19/05/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,273 0001601807297 1901011602850001
3304
Brandon
ANAK
16/02/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 99 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,274 0001601807308 1901012012640001
3307
Kim Po
PESERTA
20/12/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,275 0001601807319 1901016912810001
3307
Rini Sumarni
ISTRI
29/12/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,276 0001601807321 1901013107020001
3307
Robby
ANAK
31/07/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,277 0001601807332 1901011705480001
3310
Lie Muk Kong
PESERTA
17/05/1948
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,278 0001601807343 1901017112490001
3310
Tjandrawati
ISTRI
31/12/1949
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,279 0001601807354 1901011712840006
3310
Lie Muk Sui
TAMBAHAN
17/12/1984
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,280 0001601807365 1901016910520003
3313
Tomi Bendy
PESERTA
29/10/1952
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,281 0001601807376 1901012910520002
3313
Lei Sak Moy
ISTRI
29/11/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,282 0001601807387 1901016911560001
3313
Suryati
TAMBAHAN
07/02/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,283 0001601807398 1901014207540001
3316
Hasani
PESERTA
06/04/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,284 0001601807466 1901010101450001
3323
Sartono
PESERTA
01/01/1945
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,285 0001601807477 1901014405620001
3323
Sunarsi
ISTRI
05/04/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,286 0001601807488 1901012912930001
3323
Anjas Asmara
ANAK
29/12/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,287 0001601807499 1901016008640002
3326
Ida Budiarti
PESERTA
08/10/1984
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,288 0001601807501 1901011210410001
3327
Hasan Basri Tjhang
PESERTA
10/12/1941
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,289 0001601807512 1901011501710001
3329
Syolihin
PESERTA
15/01/1971
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,290 0001601807523 1901011104840001
3329
Sugiarto
ANAK
04/11/1984
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,291 0001601807534 1901013108560003
3331
R.P. Busono
PESERTA
31/08/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,292 0001601807545 1901010205580001
3332
M. Syamsinar
PESERTA
02/05/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,293 0001601807556 1901010110750005
3333
Muhammad Nurdin
PESERTA
01/10/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,294 0001601807567 1901014711800000
3333
Herlena
ISTRI
07/11/1980
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,295 0001601807578 1901011611050003
3333
Abdurrahman
ANAK
16/11/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,296 0001601807589 1901015508970001
3333
Nina
TAMBAHAN
15/08/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 100 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,297 0001601807591 1901010308710001
3337
RUSDINAR
PESERTA
03/08/1971
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,298 0001601807602 1901014302730003
3337
TARSI
ISTRI
03/02/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,299 0001601807613 1901014409970001
3337
TANIA SEPTIYANA
ANAK
04/09/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,300 0001601807624 1901010709920005
3340
Mayora
PESERTA
09/07/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,301 0001601807635 1901016811930008
3340
Nopiayani Tiara Kasih
ISTRI
28/11/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,302 0001601807646 1901015911110002
3340
Ressista Kalifa
ANAK
19/11/2011
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,303 0001601807657 1901011205130001
3340
Annanda Akilla
ANAK
05/12/2013
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,304 0001601807668 1901016504490004
3347
SENIAH
PESERTA
25/04/1949
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,305 0001601807679 1901012011750005
3347
A. ROJAK
ANAK
20/11/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,306 0001601807681 1901010251280001
3349
M. IKHDAM
PESERTA
11/07/1979
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,307 0001601807692 1901016705820001
3349
MUFIDAH.R
ISTRI
27/05/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,308 0001601807703 1901012811670002
3351
SUALWI PADLI
PESERTA
28/11/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,309 0001601807714 1901016007770001
3351
NUR HALIMAH
ISTRI
20/07/1977
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,310 0001601807725 1901012605660002
3353
SUWANTO
PESERTA
26/05/1968
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,311 0001601807736 1901014308690001
3353
ROMADA
ISTRI
08/03/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,312 0001601807747 1901010210000001
3353
NURDIN
ANAK
10/02/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,313 0001601807758 1901015807920005
3357
NUR KOMARIA
PESERTA
28/07/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,314 0001601807769 1901014708420002
3359
TJEUW SUI BAN
PESERTA
09/07/1942
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,315 0001601807771 1901017009810008
3360
LIANTY
PESERTA
30/09/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,316 0001601807782 1901012004080001
3360
LING MING KRISNO
ANAK
20/04/2008
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,317 0001601807793 1901015106540006
3362
NGOE KIM NGOET
PESERTA
06/11/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,318 0001601807804 1901016708850001
3362
NORIATI
ANAK
27/08/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,319 0001601807815 1901010704690004
3364
FERDIANSYAH
PESERTA
04/07/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 101 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,320 0001601807826 1901015405730003
3364
SRI RUSDIANTI
ISTRI
14/05/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,321 0001601807837 1901016712960002
3364
CHINTYA NATALIA
ANAK
27/12/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,322 0001601807848 1901015606010004
3364
CHINDY PUSPITA SARI
ANAK
16/06/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,323 0001601807859 1901016911780001
3369
ROMIAH
PESERTA
19/11/1978
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,324 0001601807861 1901011012810009
3369
DULSON
TAMBAHAN
12/10/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,325 0001601807872 1901011207760001
3371
TJHA FEN KHIONG
PESERTA
07/12/1976
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,326 0001601807883 1901015404820005
3371
AILIS
ISTRI
14/04/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,327 0001601807894 1901011211730001
3373
DEDDY DARNANTO
PESERTA
11/12/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,328 0001601807905 1901014411750002
3373
NURLELA
ISTRI
11/04/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,329 0001601807916 1901011910660001
3377
UMAR
PESERTA
19/10/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,330 0001601807927 1901016812710001
3377
SANDA HARA
ISTRI
28/12/1971
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,331 0001601807938 1901011005480006
3379
BAHTIAR HASAN
PESERTA
05/10/1948
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,332 0001601807949 1901016608620001
3380
YATUNI
PESERTA
26/08/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,333 0001601807951 1901017112410001
3382
SURATNI
PESERTA
31/12/1941
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,334 0001601807962 1901012201650001
3383
ERMADI
PESERTA
22/01/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,335 0001601807973 1901010702760003
3385
FACHRIZAL
PESERTA
02/07/1976
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,336 0001601807984 1901014907790004
3385
EVA TRIANA
ISTRI
07/09/1979
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,337 0001601807995 1901011110020002
3385
BIMO KUNTORO
ANAK
10/11/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,338 0001601808006 1901014610110002
3385
ARGISTIA MAHARANI
ANAK
10/06/2011
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,339 0001601808017 1901014805830004
3390
SISKA ANGGRAWATI
PESERTA
05/08/1983
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,340 0001601808028 1901014408010002
3390
NADA SARTIKA
ANAK
08/04/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,341 0001601808039 1901011603080001
3390
BEMBI PRESTIOPACA
ANAK
16/03/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,342 0001601808041 1901012706110003
3390
RENO FAJAR PRAYOGA
ANAK
27/06/2011
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 102 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,343 0001601808052 1901018009070002
3397
CHIKA AISYAH KIRANA
PESERTA
20/09/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,344 0001601808074 1901011212610004
3404
SUHI
PESERTA
12/12/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,345 0001601808085 1901014408670002
3404
PADILA
ISTRI
08/04/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,346 0001601808096 1901017112970001
3404
SUCI ANGGRAINI
ANAK
31/12/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,347 0001601808107 1901011610890001
3407
ROBI SANDRA
PESERTA
16/10/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,348 0001601808118 1901010901650002
3408
ARMAN
PESERTA
01/09/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,349 0001601808129 1901016401630003
3408
DARIYEM
ISTRI
24/04/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,350 0001601808131 1901014211950003
3408
RATNA
ANAK
11/02/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,351 0001601808142 1901015511970001
3408
RASWI
ANAK
15/11/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,352 0001601808175 1901015701610001
3416
KUSMIATI
PESERTA
17/01/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,353 0001601808186 1901016110860002
3416
TIARA LARASATI
ANAK
21/10/1986
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,354 0001601808197 3320071007650013
3418
SUTOMO
PESERTA
07/10/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,355 0001601808208 3320074109670002
3418
MARSIAH
ISTRI
09/01/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,356 0001601808219 1901012104650004
3420
BUDI LAKSONO
PESERTA
21/04/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,357 0001601808221 1901015404640002
3420
NUR HANI
ISTRI
14/04/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,358 0001601808232 1901010303600002
3422
ISKANDAR
PESERTA
03/03/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,359 0001601808243 1901014104650003
3422
NUR HENI
ISTRI
04/01/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,360 0001601808254 1901016304830001
3425
HAPPI DAYATI
PESERTA
23/04/1983
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,361 0001601808265 1901010107530005
3426
ASLI
PESERTA
07/01/1951
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,362 0001601808276 1901014107550017
3426
ROHMA
ISTRI
07/01/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,363 0001601808287 1901010611090001
3428
RAMLAN
PESERTA
01/05/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,364 0001601808298 1901014506620002
3428
ASMIAH
ISTRI
06/05/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,365 0001601808309 1901011601910005
3428
JANI ISKANDAR
ANAK
16/01/1991
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 103 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,366 0001601808311 1901016206970003
3428
HALIMAH
ANAK
22/06/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,367 0001601808322 1901010202600002
3440
SRI WARKAM
PESERTA
02/02/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,368 0001601808333 1901014504610003
3440
MARYAM
ISTRI
04/05/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,369 0001601808344 1901014401550005
3442
NURHAYATI
PESERTA
01/04/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,370 0001601808355 1901011711660004
3442
NURDIN
TAMBAHAN
17/11/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,371 0001601808366 1901012202560005
3450
IBNU HADJAR
PESERTA
22/02/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,372 0001601808377 1901014712660002
3450
CHAZANAH
ISTRI
07/12/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,373 0001601808388 1901010306440001
3452
MARZUKI ABDULLAH
PESERTA
03/06/1944
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,374 0001601808399 1901014608450009
3452
SURYANI
ISTRI
06/06/1945
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,375 0001601808401 1901010112450003
3454
AMAT PARYANI
PESERTA
12/01/1945
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,376 0001601808412 1901017112470007
3454
SRI BANUN
ISTRI
31/12/1947
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,377 0001601808423 1901017008540007
3456
ASBADILLAH
PESERTA
30/08/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,378 0001601808434 1901011710380002
3457
H. MUSTAMAN
PESERTA
17/10/1938
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,379 0001601808445 1901015205400002
3457
HJ. HOMISAH
ISTRI
12/05/1940
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,380 0001601808456 1901014411870003
3461
NORYATI
PESERTA
11/04/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,381 0001601808467 1901011210650002
3463
ZAINUDIN DJOHAR
PESERTA
10/12/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,382 0001601808478 1901014805630001
3463
LILA WIRSA
ISTRI
08/05/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,383 0001601808489 1901014112440002
3465
ANNI SIREGAR
PESERTA
01/12/1944
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,384 0001601808491 1901012104710001
3466
REGION ONESISMUS TIWOW
PESERTA
21/04/1971
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,385 0001601808502 1901016510760001
3466
OKTAVIA ROHAYU
ISTRI
25/10/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,386 0001601808513 1901016802600005
3469
DUMA RUSMALA DEWI
PESERTA
28/02/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,387 0001601808524 1901015512680001
3469
MARSAULINA
TAMBAHAN
15/12/1968
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,388 0001601808535 1901014903680001
3471
RUSTINA RIDHA
PESERTA
03/09/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 104 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,389 0001601808546 1901012002890001
3471
GABRIAN ZAMZANI
ANAK
20/02/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,390 0001601808557 1901011412940001
3471
JIDAR ZAMZANI
ANAK
14/12/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,391 0001601808568 1901010311520002
3474
KASMAD DJAMIL
PESERTA
03/11/1952
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,392 0001601808579 1901014206570001
3474
MISYAH
ISTRI
06/02/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,393 0001601808581 1901011311780001
3474
FERY ZAL
ANAK
13/11/1979
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,394 0001601808592 1901013009500001
3477
ISMAIL MUKRI
PESERTA
30/09/1950
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,395 0001601808603 1901016804530001
3477
SARINA
ISTRI
28/04/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,396 0001601808614 1901010102560002
3479
SAPARUDIN. M
PESERTA
01/02/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,397 0001601808625 1901016703580006
3479
DJARMIA
ISTRI
27/03/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,398 0001601808636 1901010205910005
3479
ZULKARNAIN
ANAK
05/02/1991
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,399 0001601808647 1901010111630001
3484
BASRI
PESERTA
11/01/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,400 0001601808658 1901016804690002
3484
ASNAWATI
ISTRI
26/04/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,401 0001601808669 1901010503900002
3484
MULYANDA
ANAK
03/05/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,402 0001601808671 1901014910930005
3484
MERY
ANAK
05/03/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,403 0001601808682 1901010712980002
3484
BAGAS
ANAK
12/07/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,404 0001601808693 1901015806540003
3489
MASINAH
PESERTA
18/06/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,405 0001601808704 1901012409760003
3490
JAMALUDIN
PESERTA
24/09/1976
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,406 0001601808715 1901015602750001
3490
ASMAWATI
ISTRI
16/02/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,407 0001601808726 1901012705970005
3490
ANDIKA MEISEPTI
ANAK
27/05/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,408 0001601808737 1901015708010000
3490
HERA OKTAVIA
ANAK
17/08/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,409 0001601808748 1901015603080003
3490
MAUZA JUWITA
ANAK
16/03/2008
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,410 0001601808759 1901015703400002
3497
AKIAU
PESERTA
17/03/1940
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,411 0001601808761 1901016205630001
3500
SURYATI
PESERTA
22/05/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 105 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,412 0001601808772 1901010101430001
3501
RAHMAD SALEH
PESERTA
01/01/1942
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,413 0001601808783 1901012412660002
3505
MARTA
PESERTA
24/12/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,414 0001601808794 1901016901730005
3505
LIYANI
ISTRI
29/01/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,415 0001601808805 1901010407010005
3505
YUDIANSYAH
ANAK
07/07/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,416 0001601808816 1901010107420006
3508
SUDIRO
PESERTA
01/07/1942
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,417 0001601808827 1901014905450001
3508
MUSTAMA
TAMBAHAN
09/06/1945
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,418 0001601808838 1901014504670003
3510
AWEN HARIS
PESERTA
04/05/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,419 0001601808849 1901014112850002
3510
KUNTUM
ANAK
01/12/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,420 0001601808851 1901016810890004
3510
NURLISA
ANAK
28/10/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,421 0001601808862 1901011010700008
3513
EZWAR
PESERTA
10/10/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,422 0001601808873 1901016003710001
3513
ROZIANA
ISTRI
20/03/1971
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,423 0001601808884 1901014505990003
3513
FIRGINIA ELVIERA
ANAK
05/05/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,424 0001601808895 1901012610030001
3513
FARIEZ ROSANOVA
ANAK
10/06/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,425 0001601808906 1901010812490004
3518
SJAFRIE M.ISA
PESERTA
08/12/1949
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,426 0001601808917 1901010807780002
3518
INDRA PRIHATIN
ANAK
07/08/1979
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,427 0001601808928 1901015801810005
3518
NURUL SUBHANI
ANAK
18/01/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,428 0001601808939
3522
SUPARDI
PESERTA
05/02/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,429 0001601808941 1901014605720001
3522
KASMAWATI
ISTRI
05/06/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,430 0001601808952 1901014803990001
3522
ISNIATI
ANAK
08/03/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,431 0001601808963 1901010312510002
3525
SYAIFUL BACHRI
PESERTA
03/12/1951
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,432 0001601808974 1901015606550001
3525
ROSMINI
ISTRI
16/06/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,433 0001601808985 1901010906920003
3529
NURLATIEF MARDIANTO
PESERTA
09/06/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,434 0001601808996 1901010101460004
3530
TUGIMAN
PESERTA
01/01/1946
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 106 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,435 0001601809007 1901016808710004
3530
MARHENI
ISTRI
28/08/1971
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,436 0001601809018 1901010810650003
3532
SUPARMAN
PESERTA
08/10/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,437 0001601809029 1901014205730002
3532
ZAKIA
ISTRI
05/02/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,438 0001601809031 1901010702010002
3532
M. AZAN SABILI
ANAK
02/07/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,439 0001601809042 1901011510530004
3535
IBNU ANANG
PESERTA
15/10/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,440 0001601809053 1901010905880001
3535
SEPTIAWANSAH
ANAK
05/09/1988
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,441 0001601809086 1901015603530001
3541
NANIK
PESERTA
02/10/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,442 0001601809097 1901010311640001
3542
ERIDA ISMAIL
PESERTA
11/03/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,443 0001601809108 1901016501700004
3542
MELFIANA
ISTRI
25/01/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,444 0001601809119 1901010101560002
3546
SYAKBAN
PESERTA
01/01/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,445 0001601809121 1901016807630002
3546
SRI YULIZAR
ISTRI
26/07/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,446 0001601809132 1901011605590001
3548
BUJANG ALINO
PESERTA
16/05/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,447 0001601809143 1901015607630001
3548
SURYANTI
ISTRI
16/07/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,448 0001601809154 1901012211620001
3550
SUROSO
PESERTA
22/11/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,449 0001601809165 1901013112740001
3550
ARYANI
ISTRI
31/12/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,450 0001601809176 1901014206420001
3552
SA'INYU
PESERTA
03/06/1942
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,451 0001601809187 1901015409580003
3553
FATMAWATI
PESERTA
14/09/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,452 0001601809198 1901016402740001
3553
RITA ERNITA
ANAK
24/02/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,453 0001601809209 1901010411000001
3553
AQSALLORSYIHANO
ANAK
11/04/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,454 0001601809211 1901014808060001
3553
NADINDA AYU AGISTA
ANAK
08/08/2006
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,455 0001601809222 1901011412690004
3557
BUSRO
PESERTA
14/12/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,456 0001601809233 1901016503710003
3557
KARTINI
ISTRI
15/02/1971
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,457 0001601809244 1901011508970002
3557
CAHAYA BUDIMAN
ANAK
15/08/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 107 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,458 0001601809255 1901012301600001
3560
ALIMIN
PESERTA
23/01/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,459 0001601809266 1901014812570001
3560
ASNATI
ISTRI
12/08/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,460 0001601809277 1901011010820018
3562
AGUS ARIYANTO
PESERTA
10/10/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,461 0001601809288 1901015208870007
3562
DINI
ISTRI
01/08/1991
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,462 0001601809299 1901011911070003
3562
ADI PRATAMA
ANAK
19/11/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,463 0001601809301 1901016308110004
3562
RAHMADONA. S
ANAK
23/08/2011
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,464 0001601809312 1901010109710002
3566
IMRAN
PESERTA
01/09/1971
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,465 0001601809323 1901015010700003
3566
PARIDA
ISTRI
10/10/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,466 0001601809334 1901016212000003
3566
PUSPITA. L
ANAK
12/12/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,467 0001601809345 1901012812060004
3566
WAHYU ADI PUTRA
ANAK
28/12/2006
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,468 0001601809356 1901011010820024
3570
MUSTAR. S
PESERTA
10/10/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,469 0001601809367 1901014801840004
3570
DWI RAHAYU
ISTRI
08/01/1983
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,470 0001601809378 1901012211060003
3570
NASRUN KHOIBAR
ANAK
22/11/2006
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,471 0001601809389 1901011211110002
3570
UBAYDILLAH. K
ANAK
20/11/2011
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,472 0001601809391 1901015607410001
3570
CIK UNAH
TAMBAHAN
30/05/1932
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,473 0001601809402 1901015802920001
3577
MARYANI
PESERTA
08/02/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,474 0001601809413 1901011410970005
3577
WISNU WARDANA
TAMBAHAN
14/10/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,475 0001601809424 1901010603930006
3581
RIKI SETIAWAN
PESERTA
08/03/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,476 0001601809435 1901011708630010
3583
HANAPI
PESERTA
17/08/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,477 0001601809446 1901017101700004
3583
MUSTIKA ATRIANY
ISTRI
21/01/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,478 0001601809457 1901015412930002
3583
ETI SUSANTI
ANAK
14/12/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,479 0001601809468 1901014608000003
3583
YUSELA FIRANI
ANAK
06/08/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,480 0001601809479 1901011909640006
3587
SUHARDI SIDIK
PESERTA
19/09/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 108 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,481 0001601809481 1901016804750006
3587
UMMU LATIFAH
ISTRI
28/04/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,482 0001601809492 1901011712970005
3587
REZA SAPUTRA
ANAK
17/12/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,483 0001601809503 1901015312110001
3587
KHOIROTUNNISA
ANAK
13/12/2011
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,484 0001601809514 1901014207130002
3587
SYAVIRA AZZAHRA
ANAK
02/07/2013
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,485 0001601809525 1901011410630004
3592
SUWANTA
PESERTA
14/10/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,486 0001601809536 1901016511670006
3592
SUNARSIH
ISTRI
25/11/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,487 0001601809547 1901014810030003
3592
RAVA OLIVIA
ANAK
08/10/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,488 0001601809558 1901010106370001
3595
KATIMAN
PESERTA
14/03/1936
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,489 0001601809569 1901014504420001
3595
PATIMAH
ISTRI
23/08/1938
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,490 0001601809571 1901012404610001
3597
MUHAMMAD LATIF
PESERTA
24/04/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,491 0001601809582 1901015211640002
3597
ASYIAH
ISTRI
12/11/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,492 0001601809593 1901012307890004
3597
INGGO HERMANSYAH
ANAK
23/07/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,493 0001601809604 1901012303940005
3597
DODI PRANTOSO
ANAK
23/03/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,494 0001601809615 1901010905870001
3603
UTOMO PRIHERMANTO
PESERTA
25/03/1988
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,495 0001601809626 1901012208960001
3603
TRIO SAPUTRA
ANAK
19/12/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,496 0001601809637 1901011807730003
3605
RAHMAT SANTOSO
PESERTA
18/07/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,497 0001601809648 1901014102710002
3605
JUNAIDAH
ISTRI
01/02/1971
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,498 0001601809659 1901012807980003
3605
BIMA PURWANDA
ANAK
31/07/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,499 0001601809661 1901015206020002
3605
MAULIDA SALSABILLA
ANAK
12/06/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,500 0001601809672 1901011208870002
3609
MADRUI
PESERTA
12/08/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,501 0001601809683 1901015302900003
3609
ANGGITA FELARIANA
ISTRI
13/02/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,502 0001601809694 1901012701100001
3609
M. ALVIN RIZKY
ANAK
27/01/2010
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,503 0001601809705 1901010703910007
3612
ADE RAMADHANI
PESERTA
07/03/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 109 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,504 0001601809716 1901016104940007
3612
SELVIA
ISTRI
21/04/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,505 0001601809727 1901011802110002
3612
M. IZAM
ANAK
18/02/2011
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,506 0001601809738 1901011509660003
3615
SAUFAN
PESERTA
27/10/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,507 0001601809749 1901014508790006
3615
SRI SUSILAWATI
ISTRI
05/08/1979
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,508 0001601809751 1901015710040003
3615
SRI RAHMADANIA
ANAK
09/05/2006
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,509 0001601809762 1901010807800003
3618
AHMAD SYAIFUL
PESERTA
08/07/1980
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,510 0001601809773 1901062028900005
3618
MARYAMAH. S
ISTRI
02/02/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,511 0001601809784 1901015311080002
3618
ASIFAH HIMATUL ULYA
ANAK
13/11/2008
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,512 0001601809795 1901010905690005
3621
IRWAN AUF
PESERTA
09/05/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,513 0001601809806 1901014603720007
3621
ERISA SAGITA
ISTRI
03/06/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,514 0001601809817 1901015512010004
3621
ADELIA PERMATA SAFITRI
ANAK
05/12/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,515 0001601809828 1901012909860005
3624
SUKANDI
PESERTA
29/09/1986
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,516 0001601809839 1901016303880004
3624
NURAHMI
ISTRI
23/03/1988
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,517 0001601809841 1901014711070002
3624
GLEDIESTA ELISYANA
ANAK
07/11/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,518 0001601809852 1901011305120001
3624
M. LUKMAN NULKARIM
ANAK
13/05/2012
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,519 0001601809863 1901012808500001
3628
ATUNG HUSIN
PESERTA
11/06/1948
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,520 0001601809874 1901016001520002
3628
SUMIATI
ISTRI
08/04/1952
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,521 0001601809885 1901010909530001
3630
YAKUB EFFENDI
PESERTA
09/09/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,522 0001601809896 1901016710710005
3630
ATRI SURYANTI
ISTRI
26/10/1971
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,523 0001601809907 1901010909960004
3630
ERIKO RIVALDI
ANAK
09/09/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,524 0001601809918 1901012610010001
3630
ERISWANDA
ANAK
25/10/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,525 0001601809929 1901016602650001
3634
NURLELA
PESERTA
19/02/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,526 0001601809931 1901015501910001
3634
VELLY RIZKY. F
ANAK
15/01/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 110 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,527 0001601809942 1901017108050004
3634
AUGUSTRI SALSABILLA
ANAK
31/08/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,528 0001601809953 1901012008650001
3637
AWANG RUSMAN
PESERTA
23/03/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,529 0001601809964 1901016410700007
3637
MEDIYANITA
ANAK
24/10/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,530 0001601809975 1901010204720004
3637
HASANTO
ANAK
02/04/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,531 0001601809986 1901011507810005
3640
IRWANSYAH. SE
PESERTA
15/07/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,532 0001601809997 1901014305940008
3640
LISMA YUVITA
ISTRI
03/05/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,533 0001601810008 1901013004130002
3640
KHAIRAN ADIYASTHA
ANAK
30/04/2013
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,534 0001601810019 1901010102070008
3645
JORDY FEBRIANSYAH
PESERTA
01/02/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,535 0001601810021 1901017007110001
3645
CHERRYL ZELVIA
TAMBAHAN
30/07/2011
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,536 0001601810032 1901012512710011
3651
ERVANI
PESERTA
25/12/1971
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,537 0001601810043 1901014502780006
3651
SRI MARHASIYATINI
ISTRI
05/02/1978
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,538 0001601810054 1901014705000004
3651
GEA RATRI NINGSIH
ANAK
07/05/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,539 0001601810087 1901016112790003
3660
NARTI
PESERTA
21/12/1979
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,540 0001601810098 1901011910020001
3660
REILIBRA INMDIENOV VALKA
ANAK
19/10/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,541 0001601810109 1901011610080001
3660
FIRLIISHAM BAJILAH
ANAK
16/10/2008
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,542 0001601810111 1901011403130001
3663
DAMA FAJRUL FALAH
PESERTA
14/03/2013
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,543 0001601810122 1901010510660001
3664
SUWANDI
PESERTA
05/10/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,544 0001601810133 1901016402720003
3664
NURAINA
ISTRI
24/02/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,545 0001601810144 1901016402970001
3664
NURSA'DA
ANAK
24/02/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,546 0001601810155 1901010205100002
3664
LATIFA
ANAK
02/05/2010
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
2,547 0001601810166 1901011204620008
3668
JUMAI
PESERTA
12/04/1962
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,548 0001601810177 1901014710690002
3668
ROMLAH
ISTRI
07/10/1969
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,549 0001601810188 1901014505020008
3668
JURIAH
ANAK
05/05/2002
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 111 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,550 0001601810199 1901015611030005
3668
DONA
ANAK
16/11/2003
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,551 0001601810201 1901016005050003
3668
TARI
ANAK
20/06/2005
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,552 0001601810212 1901015003310002
3674
DAHARA
PESERTA
10/03/1931
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,553 0001601810223 1901015007740005
3675
NURMALA
PESERTA
10/07/1974
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,554 0001601810234 1901017012980001
3675
DELTA DEVITASARI
ANAK
30/12/1998
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,555 0001601810245 1901015203030002
3675
MARETHA
ANAK
12/03/2003
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,556 0001601810256 1901015508550000
3678
SAUDA M
PESERTA
15/08/1955
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,557 0001601810267 1901016507620002
3679
ROSILAWATI
PESERTA
25/07/1962
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,558 0001601810278 1901010409870002
3679
FISKA
ANAK
04/09/1987
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,559 0001601810289 1901010701580016
3681
YURI
PESERTA
07/01/1958
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,560 0001601810291 1901012911900001
3681
MARYAMA
ISTRI
07/01/1959
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,561 0001601810302 1901011507410001
3683
ASMAH
PESERTA
10/05/1959
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,562 0001601810313 1604060808820003
3684
LAURU
PESERTA
15/07/1941
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,563 0001601810324 1604064708820004
3684
SAFERON
ANAK
10/10/1963
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,564 0001601810335 1604062007040003
3684
DARWIN
ANAK
15/03/1969
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,565 0001601810346 1901012110850002
3687
RANDA JULIANSYAH
PESERTA
26/07/1954
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,566 0001601810357 1901010806110017
3688
RANGGA JULIANSYAH
PESERTA
26/07/2004
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,567 0001601810368 1901015411480001
3688
MUSTAM SARMOJO
TAMBAHAN
04/07/1954
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,568 0001601810379 1606010203520001
3690
NG AHIAN
PESERTA
23/08/1960
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,569 0001601810381 1606015704740000
3690
HASAN SALE LATIP
ANAK
11/10/1951
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,570 0001601810392 1606015910040002
3690
YJHIN DJUNG NAM
ANAK
02/02/1938
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,571 0001601810403 1606010503060003
3690
LIM SOEI NIO
ANAK
14/11/1948
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,572 0001601810414 1901014203520002
3694
HASAN BASRI
PESERTA
02/03/1952
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 112 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,573 0001601810425 1901011910550004
3695
SOPIAN AS
PESERTA
01/08/1952
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,574 0001601810436 1901015405740006
3695
RUSNI WH
ISTRI
04/07/1952
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,575 0001601810447 1901015001920003
3697
AMAN
PESERTA
19/10/1955
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,576 0001601810458 1901011104120002
3697
DARNA
ISTRI
14/05/1974
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,577 0001601810469 1901010604140001
3697
NIATI
ANAK
14/05/1993
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,578 0001601810471 1901010203710003
3700
DIAN
PESERTA
22/04/2000
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,579 0001601810482 1901015812730001
3700
RAPITA
TAMBAHAN
14/07/2001
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,580 0001601810493 1901010804990003
3700
WULAN
TAMBAHAN
15/02/2005
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,581 0001601810504 1901010103080003
3700
MARTIN
TAMBAHAN
07/03/1962
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,582 0001601810515 1901014904600002
3705
ASNI
PESERTA
10/01/1971
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,583 0001601810526 1901015011910011
3705
RICO AAFRIANTO
ANAK
20/04/1989
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,584 0001601810537 1901011008930005
3705
JUNIATI
ANAK
30/01/1991
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,585 0001601810548 1901012801430001
3708
AIRA HABSAH
PESERTA
06/11/2009
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,586 0001601810559 1901012801450002
3708
MAH DARNA
TAMBAHAN
10/05/1950
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,587 0001601810561 1901015211280002
3710
RENDI ENRICO FARMI
PESERTA
11/07/1990
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,588 0001601810572 1901015707700004
3711
LIOE DJIT TJEN
PESERTA
02/03/1971
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,589 0001601810583 1901014110610006
3712
DESSY ARIYANTI H
PESERTA
18/12/1973
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,590 0001601810594 1901010904600003
3713
ERNA
PESERTA
09/04/1960
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,591 0001601810605 1901016010500003
3714
ABDUL KARIM
PESERTA
28/01/1943
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,592 0001601810616 1901011302740004
3715
SUTINAH
PESERTA
12/04/1950
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,593 0001601810627 1901014407040012
3715
LIU LIAN TJHIN
TAMBAHAN
12/11/1928
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,594 0001601810638 1901015805080001
3715
LIU DJIT NYA
TAMBAHAN
08/10/1969
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,595 0001601810649 1901010702410001
3718
HOMSAH
PESERTA
17/08/1959
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 113 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,596 0001601810651 1901015110450001
3718
SYAMSIAR
ANAK
10/03/1970
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,597 0001601810662 1901010904750006
3720
SRI ASTUTI
PESERTA
17/07/1970
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,598 0001601810673 1901015712730004
3720
SAHANA
TAMBAHAN
01/10/1961
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,599 0001601810684 1901015612010003
3720
AMRIAH
TAMBAHAN
15/10/1947
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,600 0001601810695 1901011712030003
3720
SYAMINAH
TAMBAHAN
13/05/1964
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,601 0001601810706 1901012508080002
3720
SELAHUT
TAMBAHAN
10/03/1934
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,602 0001601810717 1901016404100003
3720
ACHMAD SIRUN
TAMBAHAN
03/05/1950
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,603 0001601810728 1901011005820008
3726
HADIYUN
PESERTA
03/05/1942
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,604 0001601810739 1901015500680001
3726
BASIR
TAMBAHAN
15/07/1945
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,605 0001601810741 1901010809690008
3728
FATIMAH
PESERTA
20/10/1950
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,606 0001601810752 1901011608780008
3728
K. BENNY AGUSTIAN
ANAK
13/02/1974
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,607 0001601810763 1901015005530005
3730
SUHETI
PESERTA
06/08/1974
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,608 0001601810774 1901016607860007
3732
ECHA ALQURYANI
PESERTA
04/07/2004
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,609 0001601810785 1901016405000007
3733
RACHMAD
PESERTA
07/02/1941
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,610 0001601810796 1901010809040004
3733
ROMINA
ISTRI
11/10/1945
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,611 0001601810807 1901014804750002
3733
VIONA MEYLANDA.P
ANAK
18/05/2008
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,612 0001601810818 1901011410650002
3736
Abdul Rahman Saragih
PESERTA
14/10/1965
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,613 0001601810829 1901014304720005
3736
Nuraina
ISTRI
03/04/1972
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,614 0001601810831 1901016201990003
3736
Ayu Annisa Dewi Saragih
ANAK
22/01/1999
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,615 0001601810842 1901012703060002
3736
Bayu Saputra Saragih
ANAK
27/03/2006
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,616 0001601810853 1901015210130001
3741
ZAHRA OKTOVIA
PESERTA
12/10/2013
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,617 0001601810864 1901011112650002
3742
DARUSMAN
PESERTA
11/12/1965
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,618 0001601810875 1901014610650001
3742
MISNAH
ISTRI
06/10/1965
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 114 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,619 0001601810886 1901012607950002
3742
AHMAD ABRORI SIDIK
ANAK
26/07/1995
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,620 0001601810897 1901014705980003
3742
ALFIAT NUR KHAYAH
ANAK
07/05/1998
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,621 0001601810908 1901014111000009
3742
NUR AINUN
ANAK
01/11/2000
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,622 0001601810919 3209032105510001
3747
JUREDI
PESERTA
21/05/1951
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,623 0001601810921 3209035002560005
3747
FATIMAH
ISTRI
10/02/1959
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,624 0001601810932 1901010505890001
3747
ARKANI
ANAK
05/05/1989
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,625 0001601810943 3209030606920002
3747
M. AGUS SOFYAN
ANAK
06/06/1992
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,626 0001601810954 1901011107490003
3751
FAISAL
PESERTA
11/07/1949
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,627 0001601810965 1901014210570003
3751
ROLUS POLUS
ISTRI
02/10/1957
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,628 0001601810976 1901010506870003
3751
HENDRA
ANAK
05/06/1987
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,629 0001601810987 1901012311900001
3751
HENDRY
ANAK
23/11/1990
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,630 0001601810998 1901010312820001
3755
SYAFARI KARYAWIJAYA
PESERTA
03/12/1982
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,631 0001601811009 1901015403820004
3755
ROSNAH
ISTRI
14/03/1982
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,632 0001601811011 1901010208100002
3755
FADIL ADRIAN
ANAK
02/06/2010
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,633 0001601811022 1901014304910004
3758
NOVITA SARI
PESERTA
03/04/1991
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,634 0001601811033 1901016809130001
3758
NAURA CINTA AFAANIN
ANAK
28/09/2013
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,635 0001601811044 1901016212810001
3761
NORMAH
PESERTA
22/12/1961
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,636 0001601811055 1901014107540013
3763
MARIANI
PESERTA
01/07/1954
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,637 0001601811066 1901011907860008
3763
RUSIANTO
ANAK
19/07/1986
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,638 0001601811077 1901010112890013
3763
FARIZAL
ANAK
01/12/1989
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,639 0001601811088 1901010402470001
3766
AHDI ARIH
PESERTA
04/02/1947
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,640 0001601811099 1901014909560003
3766
CIK SEBA
ISTRI
09/09/1958
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,641 0001601811101 1901014704650004
3770
SURYA
PESERTA
07/04/1965
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 115 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,642 0001601811112 1901011108450001
3771
SUHADI
PESERTA
11/08/1945
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,643 0001601811123 1901012903760004
3771
SUHERMAN
ANAK
29/03/1976
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,644 0001601811134 1901012510810002
3771
SUHERDAN
ANAK
25/10/1981
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,645 0001601811145 1901010208690004
3774
AHMAD
PESERTA
02/08/1969
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,646 0001601811156 1901014609670003
3774
RUSNIHATI
ISTRI
06/09/1967
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,647 0001601811167 1901010412940004
3774
RIZDO ALFINSAR
ANAK
04/12/1994
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,648 0001601811178 1901016111050003
3774
AUFA TRI SYAHWA
ANAK
21/11/2005
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,649 0001601811189 1901016307440001
3774
MUHAYA
TAMBAHAN
23/07/1944
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,650 0001601811191 1901014107650026
3780
SUTIANA
PESERTA
01/07/1965
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,651 0001601811202 1901011004190001
3781
IBRAHIM MATAGI
PESERTA
10/04/1919
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,652 0001601811213 1901016009660006
3781
ROHMAH
ANAK
20/09/1966
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,653 0001601811224 1901016007410003
3783
KASINA
PESERTA
20/07/1941
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,654 0001601811235 1901011905790003
3784
ENDRI SAPRAWI
PESERTA
19/05/1979
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,655 0001601811246 1901016103280001
3785
TJEN A TJIOEK
PESERTA
21/03/1928
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,656 0001601811257 1901012006640002
3786
NAM FO
PESERTA
20/06/1964
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,657 0001601811268 1901016206780004
3786
AT JIT
ISTRI
22/06/1978
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,658 0001601811279 1901015006950002
3786
RIKA PRATIWI
ANAK
10/06/1995
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,659 0001601811281 1901011105540004
3789
TJEN A HIN
PESERTA
11/05/1951
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,660 0001601811292 1901014303660007
3789
TJIOE NGIAT FUN
ISTRI
03/03/1966
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,661 0001601811303 1901014807540004
3791
JAWARIAH
PESERTA
08/07/1954
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,662 0001601811314 1901010107580008
3791
HALIMAH
TAMBAHAN
01/07/1958
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,663 0001601811325 1901011701650003
3793
ISMAIL
PESERTA
17/01/1965
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,664 0001601811336 1901014607630002
3793
ASNAH
ISTRI
06/07/1963
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 116 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,665 0001601811347 1901014711940001
3793
DWI REGITA SAPUTRI
ANAK
07/11/1994
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,666 0001601811358 1901014102250001
3793
HATIMAH
TAMBAHAN
01/02/1926
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,667 0001601811369 1901014702490002
3797
KODRATTI
PESERTA
07/02/1949
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,668 0001601811371 1901012112630004
3798
SUHAIMI
PESERTA
21/12/1963
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,669 0001601811382 1901014108640006
3798
ROSNAH
ISTRI
01/08/1964
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,670 0001601811393 1901016205730001
3800
AMINAH
PESERTA
22/05/1973
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,671 0001601811404 1901014910930002
3800
WENNI SANDI ARANTIKA
ANAK
10/09/1993
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,672 0001601811415 1901014401970002
3800
WINDA SANDI NOVA
ANAK
01/04/1997
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,673 0001601811426 1901014406040005
3800
JEAN AMANDA
ANAK
06/04/2004
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,674 0001601811437 1901016704100002
3800
KHALISYA PUTRI
ANAK
27/04/2010
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,675 0001601811448 1901011011610001
3805
SUTJIPTO
PESERTA
11/10/1961
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,676 0001601811459 1901014702950006
3805
UCI OKTARIZA
ANAK
02/07/1995
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,677 0001601811461 1901011002840003
3807
SARKASI
PESERTA
02/10/1984
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,678 0001601811472 1901015708820006
3807
FADILA
ISTRI
17/08/1982
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,679 0001601811483 1901012512130001
3807
NABIL PRATAMA
ANAK
25/12/2013
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,680 0001601811494 1901015104580001
3807
ASRI
TAMBAHAN
04/11/1958
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,681 0001601811505 1777106291088005
3811
Ade Putra
PESERTA
19/10/1988
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,682 0001601811516 1771065901890002
3811
Januaritha Dwi Marsudia Putri
ISTRI
19/01/1989
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,683 0001601811527 1771060807090001
3811
Dentha Bima Sakti
ANAK
07/08/2009
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,684 0001601811549 1901012904710001
3815
RABEALI
PESERTA
29/04/1974
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,685 0001601811551 1901015606770001
3815
SURIANA
ISTRI
22/12/1977
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,686 0001601811562 1901014508000001
3815
DEA PRATIWI
ANAK
08/05/2000
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
2,687 0001601811573 1901016102060001
3815
DESI AZIZAH
ANAK
21/12/2006
SINAR BARU
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 117 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,688 0001601811584 1901071007510001
3819
Karimin
PESERTA
10/07/1951
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,689 0001601811595 1901074906530001
3819
Patimah
ISTRI
09/06/1953
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,690 0001601811606 1901072511790002
3819
Pardi
ANAK
25/11/1979
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,691 0001601811617 1901072404730001
3822
Suhardi
PESERTA
24/04/1973
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,692 0001601811628 1901075704840002
3822
Liza
ISTRI
17/04/1984
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,693 0001601811639 1901074305010002
3822
Holipah
ANAK
03/05/2001
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,694 0001601811641 1901075907040003
3822
Siti Hariyana
ANAK
19/07/2004
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,695 0001601811652 1901075102080002
3822
Mauziah
ANAK
11/02/2008
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,696 0001601811663 1901072112730001
3827
Karmawan
PESERTA
21/12/1973
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,697 0001601811674 1901074710760001
3827
Sunar
ISTRI
07/10/1976
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,698 0001601811685 1901073007950001
3827
Ahmad Baqiah
ANAK
30/07/1995
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,699 0001601811696 1901072604050001
3827
Sualdi
ANAK
26/04/2005
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,700 0001601811707 1901071709880001
3831
Haris Padilah
PESERTA
17/09/1988
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,701 0001601811718 1901075505920001
3831
Yunawati
ISTRI
15/05/1992
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,702 0001601811729 1901071210090001
3831
Reyhan Pratama
ANAK
12/10/2009
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,703 0001601811731 1901070809620001
3834
A. Tarmuzi
PESERTA
08/09/1962
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,704 0001601811742 1901075002660001
3834
Patonah
ISTRI
10/02/1966
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,705 0001601811753 1901075909980001
3834
Ucha Syapitri
ANAK
19/09/1998
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,706 0001601811764 1901071606020001
3834
Lofi Syaputra
ANAK
16/06/2002
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,707 0001601811775 1905041002810003
3838
ZamHari
PESERTA
10/02/1981
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,708 0001601811786 1901074806870003
3838
Siska Widya
ISTRI
08/06/1987
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,709 0001601811797 1901073012120002
3838
Najwan Ilham
ANAK
30/12/2012
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,710 0001601811808 1901071007800002
3841
Ruslan
PESERTA
10/07/1980
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 118 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,711 0001601811819 1901074107860021
3841
Depi
ISTRI
01/07/1986
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,712 0001601811821 1901072604080001
3841
Muhamad Zaid
ANAK
26/04/2008
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,713 0001601811832 1901074412100001
3841
Leva Noviya
ANAK
04/12/2010
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,714 0001601811843 1901071505880002
3845
Deny
PESERTA
15/05/1988
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,715 0001601811854 1901075808880001
3845
Eka Yusnita
ISTRI
18/08/1988
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,716 0001601811865 1901071405060002
3845
Ezi Finanda
ANAK
14/05/2006
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,717 0001601811876 1901072104640003
3848
Rustam
PESERTA
21/04/1954
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,718 0001601811887 1901074304640002
3848
Solihah
ISTRI
02/04/1964
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,719 0001601811898 1901071212610002
3850
Tamran
PESERTA
12/12/1961
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,720 0001601811909 1901076302670002
3850
Suriati
ISTRI
23/02/1967
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,721 0001601811911 1901071404790001
3852
Murad
PESERTA
14/04/1979
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,722 0001601811922 1901075103090001
3852
Mirna Zalianti
ANAK
11/03/2009
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,723 0001601811933 1901042901950003
3854
Kasirman
PESERTA
29/01/1993
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,724 0001601811944 1901075502960001
3854
Gita Deviana
ISTRI
15/02/1996
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,725 0001601811955 1901070908130001
3854
Anzi Anzema
ANAK
09/08/2013
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,726 0001601811966 1901070306520001
3857
Kasiran
PESERTA
03/06/1952
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,727 0001601811977 1901075311640001
3857
Ratna
ISTRI
13/11/1964
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,728 0001601811988 1901073011950001
3857
Arbi
ANAK
30/11/1995
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,729 0001601811999 1901070103700003
3860
Marzali
PESERTA
01/03/1970
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,730 0001601812001 1901076607830001
3860
Yulianti
ISTRI
26/07/1993
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,731 0001601812012 1901075110990002
3860
Grisya Reka Santika
ANAK
11/10/1999
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,732 0001601812023 1901072508090003
3860
Reski Alfiansyah
ANAK
25/08/2009
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,733 0001601812034 1901075212990003
3860
Tamara
TAMBAHAN
12/12/1999
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 119 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,734 0001601812045 1901071010600002
3865
M. Jumadi
PESERTA
10/10/1960
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,735 0001601812056 1901075411650002
3865
Jamila
ISTRI
14/11/1965
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,736 0001601812067 1901072711920002
3865
M. Ilham Gazali
ANAK
27/11/1992
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,737 0001601812078 1901072507970001
3865
M. Glora Susanto
ANAK
25/07/1997
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,738 0001601812089 1901072104850003
3869
M. Aswad Faizal
PESERTA
21/04/1985
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,739 0001601812091 1905056002890001
3869
Siti Zahara
ISTRI
21/02/1989
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,740 0001601812102 1901075507130001
3869
Nur Zevi Ramadani
ANAK
15/07/2013
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,741 0001601812113 1901070508790002
3872
Ishak
PESERTA
05/08/1979
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,742 0001601812124 1901074206830003
3872
Jamisah
ISTRI
02/06/1983
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,743 0001601812135 1901071404090001
3872
Pedi Arianses
ANAK
14/04/2009
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,744 0001601812146 1901071909790001
3875
Rusman
PESERTA
19/09/1979
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,745 0001601812157 1901076006650006
3875
Asni
ISTRI
20/06/1995
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,746 0001601812168 1901076803100001
3875
Mika
ANAK
28/03/2010
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,747 0001601812179 1901072507770002
3878
Zarmawi
PESERTA
25/07/1977
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,748 0001601812181 1901076707830003
3878
Suriani
ISTRI
27/07/1983
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,749 0001601812192 1901074609000003
3878
Sri Wahyuni
ANAK
06/09/2000
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,750 0001601812203 1901070209050005
3878
Rausyan Fikri
ANAK
02/09/2005
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,751 0001601812214 1901071012830002
3882
Hermawan
PESERTA
10/12/1983
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,752 0001601812225 1901074201860003
3882
Yati
ISTRI
02/01/1986
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,753 0001601812236 1901076005060002
3882
Amey Lerian
ANAK
20/05/2005
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,754 0001601812247 1901070305120001
3882
Kanza Viscara
ANAK
03/05/2012
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,755 0001601812258 1901071406540003
3886
Toyib
PESERTA
14/06/1954
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,756 0001601812269 1901074308550003
3886
Rusla
ISTRI
03/08/1955
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 120 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,757 0001601812271 1901070705800002
3888
Hendra
PESERTA
07/05/1980
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,758 0001601812282 1901075802870001
3888
Fitri
ISTRI
18/02/1987
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,759 0001601812293 1901070302080001
3888
Pitun Saputra
ANAK
03/02/2008
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,760 0001601812304 1901075111120004
3888
Lisnawati
ANAK
11/11/2012
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,761 0001601812315 1901070707800002
3892
Padli
PESERTA
07/07/1980
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,762 0001601812326 1901075509800004
3892
Karmila
ISTRI
15/09/1980
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,763 0001601812337 1901071508010001
3892
Ahmad Rudian
ANAK
15/08/2001
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,764 0001601812348 1901071403120001
3892
Andra
ANAK
14/03/2012
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,765 0001601812359 1901076712730001
3897
Ida Laila
PESERTA
27/12/1973
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,766 0001601812361 1901077006910001
3897
Nina Listiana
ANAK
30/06/1991
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,767 0001601812372 1901076401020065
3897
Hafizah Wulandari
ANAK
24/01/2001
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,768 0001601812383 1901070507810001
3900
Ambus
PESERTA
05/07/1981
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,769 0001601812394 1901075112800001
3900
Maliya
ISTRI
11/12/1980
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,770 0001601812405 1901075211010002
3900
Atika Suri
ANAK
12/11/2001
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,771 0001601812416 1901072812050001
3900
Chandra
ANAK
28/12/2005
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,772 0001601812427 1901071909800001
3904
Yossudarso
PESERTA
19/09/1980
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,773 0001601812438 1901074502850001
3904
Ida Royani
ISTRI
05/02/1985
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,774 0001601812449 1901074904050002
3904
Anisa Aura Ulfa
ANAK
09/04/2005
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,775 0001601812451 1901070505810001
3907
Dedi
PESERTA
05/05/1981
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,776 0001601812462 1901075807820002
3907
Zainun
ISTRI
18/07/1982
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,777 0001601812473 1901074401020002
3907
Dena Ulandari
ANAK
04/01/2002
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,778 0001601812484 1901074106810006
3910
Yulnawati
PESERTA
01/08/1981
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,779 0001601812495 1901075711130003
3910
Nailul Muna
ANAK
17/11/2013
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 121 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,780 0001601812506 1901074507980002
3910
Soleha
TAMBAHAN
05/07/1998
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,781 0001601812517 1901074505010002
3910
Rahmayana
TAMBAHAN
05/05/2001
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,782 0001601812528 1901071112430001
3914
Mohamad Arif
PESERTA
11/12/1943
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,783 0001601812539 1901076006500001
3914
Rohah
ISTRI
20/06/1950
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,784 0001601812541 1901074305730002
3914
Sugia
ANAK
03/05/1973
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,785 0001601812552 1901071502820002
3914
Rodion
ANAK
15/02/1982
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,786 0001601812563 1901072309840002
3914
Heridusteri
ANAK
23/09/1984
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,787 0001601812574 1901075501860002
3914
Urasi Yani
ANAK
15/01/1986
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,788 0001601812585 1901070107670003
3920
Indera
PESERTA
01/07/1987
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,789 0001601812596 1901074107720003
3920
Saiti
ISTRI
03/04/1974
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,790 0001601812607 1901070202880001
3922
Jali
PESERTA
02/02/1988
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,791 0001601812618 1905044107910048
3922
Nuraina
ISTRI
23/05/1990
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,792 0001601812629 1901075406120001
3922
Alini
ANAK
14/06/2012
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,793 0001601812631 1901076612130001
3922
Lisa
ANAK
26/12/2013
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,794 0001601812642 1901071705510001
3926
Idris
PESERTA
17/05/1951
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,795 0001601812653 1901074311630001
3926
Rusnah Patimah
ISTRI
03/11/1963
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,796 0001601812664 1901070704580001
3928
Tamar
PESERTA
07/04/1958
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,797 0001601812675 1901074807560001
3928
Hamenah
ISTRI
08/07/1958
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,798 0001601812686 1901075407500001
3930
Zainaf
PESERTA
14/07/1991
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,799 0001601812697 1901071709590001
3931
Solihin
PESERTA
17/09/1959
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,800 0001601812708 1901074608590001
3931
Aini
ISTRI
06/08/1959
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,801 0001601812719 1901074812630001
3933
Diana
PESERTA
08/12/1963
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,802 0001601812721 1901070310800001
3933
Daksun
ANAK
03/10/1980
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 122 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,803 0001601812732 1901071308880002
3935
Abdullah
PESERTA
13/08/1988
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,804 0001601812743 1901074108890001
3935
Runi
ISTRI
08/01/1989
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,805 0001601812754 1901071102120002
3935
Sapri
ANAK
02/11/2012
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,806 0001601812765 1901070301800003
3938
Ruslan
PESERTA
01/03/1980
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,807 0001601812776 1901075508850002
3938
Yana
ISTRI
15/08/1985
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,808 0001601812787 1901076510040001
3938
Mirnawati
ANAK
25/10/2004
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,809 0001601812798 1901075403130001
3938
Marsa
ANAK
14/03/2013
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,810 0001601812809 1901070510590001
3942
Usim
PESERTA
10/05/1959
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,811 0001601812811 1901074207670002
3942
Cikmis
ISTRI
07/02/1967
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,812 0001601812822 1901071705970001
3942
Solihin
ANAK
15/05/1997
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,813 0001601812833 1901075108980001
3942
Surita
ANAK
08/11/2014
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,814 0001601812844 1901071801730001
3946
Ahmad Jais
PESERTA
18/01/1973
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,815 0001601812855 1901074608760002
3946
Rahirti
ISTRI
06/08/1976
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,816 0001601812866 1901070906960003
3946
Zainal Arifin
ANAK
09/06/1996
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,817 0001601812877 1901074710980001
3946
Asnani
ANAK
07/10/1998
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,818 0001601812888 1901072311910001
3950
Jemi
PESERTA
23/11/1991
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,819 0001601812899 1901024711930001
3950
Tika
ISTRI
07/11/1993
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,820 0001601812901 1901075111120003
3950
Sinta Dewi
ANAK
11/11/2012
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,821 0001601812912 1901071404650003
3953
Jumin
PESERTA
14/04/1965
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,822 0001601812923 1901075106680001
3953
Kamisah
ISTRI
11/06/1968
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,823 0001601812934 1901075312950001
3953
Nurhayati
ANAK
13/12/1995
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,824 0001601812945 1901076911080001
3953
Ilyasa
ANAK
29/11/2008
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,825 0001601812956 1901071002820002
3957
Sudirman
PESERTA
10/02/1982
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 123 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,826 0001601812967 1901075710860001
3957
Soni
ISTRI
17/10/1986
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,827 0001601812978 1901077006060003
3957
Adinda Resmawati
ANAK
30/06/2006
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,828 0001601812989 1901071009870002
3960
Haria
PESERTA
10/09/1987
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,829 0001601812991 1901075505880003
3960
Hariati
ISTRI
15/05/1988
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,830 0001601813002 1901075807090002
3960
Aulia Bestari
ANAK
18/07/2009
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,831 0001601813013 1901074411400001
3963
Laila
PESERTA
04/11/1940
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,832 0001601813024 1901075506630001
3963
Ana
ANAK
15/06/1963
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,833 0001601813035 1901071707510001
3965
Asri
PESERTA
17/07/1961
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,834 0001601813046 1901077112500002
3965
Asni
ISTRI
31/12/1960
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,835 0001601813057 1901075103570001
3968
Senah
PESERTA
03/04/1961
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,836 0001601813068 1901075003590003
3969
Tamiah
PESERTA
10/03/1959
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,837 0001601813079 1901074704940001
3969
Susi
ANAK
07/04/1994
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,838 0001601813081 1901070811350001
3971
Malik
PESERTA
08/11/1935
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,839 0001601813092 1901075107470001
3971
Hamsiah
ISTRI
11/07/1947
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,840 0001601813103 1901071303500003
3973
Zainal Arifin
PESERTA
13/03/1950
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,841 0001601813114 1901071404740003
3974
As'at
PESERTA
14/04/1974
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,842 0001601813125 1901075310810002
3974
Zaila
ISTRI
13/10/1981
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,843 0001601813136 1901072511990002
3974
Ari Wibowo
ANAK
25/11/1999
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,844 0001601813147 1901074409040002
3974
Rossa
ANAK
04/09/2004
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,845 0001601813158 1901071201300002
3974
Arsah
TAMBAHAN
12/01/1930
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,846 0001601813169 1901074511400002
3974
Salbiah
TAMBAHAN
05/11/1940
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,847 0001601813171 1901071706670001
3980
Anuar
PESERTA
17/06/1967
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,848 0001601813182 1901076606730002
3980
Yulianti
ISTRI
26/06/1973
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 124 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,849 0001601813193 1901073003940002
3980
Minan
ANAK
30/03/1994
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,850 0001601813204 1901073003940001
3980
minin
ANAK
30/03/1994
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,851 0001601813215 1901071504970001
3980
Karunia Untung
ANAK
15/04/1997
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,852 0001601813226 1901070906060002
3980
Mardian Saputra
ANAK
09/06/2006
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,853 0001601813237 1901076210080001
3980
Reka Minanti
ANAK
22/10/2008
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,854 0001601813248 1901076601140001
3980
Azzahra
ANAK
25/01/2014
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,855 0001601813259 1901071010820003
3988
Kusmadi
PESERTA
10/10/1982
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,856 0001601813261 1901075802860002
3988
Ratmi
ISTRI
18/02/1986
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,857 0001601813272 1901076707060001
3988
ririn
ANAK
27/07/2008
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,858 0001601813283 1901075404130001
3988
Keysa Husna
ANAK
14/04/2013
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,859 0001601813294 1901071602790001
3992
Edi Silitonga
PESERTA
16/02/1979
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,860 0001601813305 1901074101820002
3992
Yetioktopia
ISTRI
01/01/1982
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,861 0001601813316 1901075302020003
3992
Monika
ANAK
13/02/2007
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,862 0001601813327 1901070901810001
3995
Ali Usman
PESERTA
09/01/1981
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,863 0001601813338 1901076005880003
3995
Husnul Adha
ISTRI
20/05/1988
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,864 0001601813349 1901075307110001
3995
Zakia Purnaya
ANAK
13/07/2011
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,865 0001601813351 1901074607700002
3998
Maimunah
PESERTA
06/07/1970
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,866 0001601813362 1901071006870003
3998
Muhai
ANAK
10/06/1987
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,867 0001601813373 1901071106960001
3998
Rozali
ANAK
11/06/1996
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,868 0001601813384 1901075805010001
3998
Marina
ANAK
18/05/2001
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,869 0001601813395 1901070409860001
4002
Maradona
PESERTA
04/09/1986
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,870 0001601813406 1901074101930005
4002
Suni
ISTRI
01/01/1993
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,871 0001601813417 1901071007100002
4002
Wahyuda
ANAK
10/07/2010
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 125 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,872 0001601813428 1901072807570002
4005
Suki
PESERTA
28/07/1957
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,873 0001601813439 1901076608600001
4005
Indun
ISTRI
26/08/1960
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,874 0001601813441 1901070502840001
4005
Risyanto
ANAK
05/02/1984
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,875 0001601813452 1901076904900001
4005
Wati
ANAK
29/04/1990
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,876 0001601813463 1901072806910002
4005
Andri
ANAK
28/06/1991
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,877 0001601813474 1901072106960001
4005
Oma
ANAK
21/06/1996
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,878 0001601813485 1901071601980002
4005
Rusi
ANAK
16/01/1998
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,879 0001601813496 1901070702600001
4012
Mahmud
PESERTA
07/02/1960
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,880 0001601813507 1901074908690002
4012
Asnah
ISTRI
09/08/1969
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,881 0001601813518 1901074410970001
4012
Siti Nurrohmah
ANAK
04/10/1997
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,882 0001601813529 1901070609990001
4012
Wali Pajri
ANAK
06/09/1999
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,883 0001601813531 1901071512700001
4016
Mahrup
PESERTA
15/12/1970
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,884 0001601813542 1901075706740003
4016
Darna
ISTRI
17/06/1974
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,885 0001601813553 1901071406910001
4016
Darmanto
ANAK
14/06/1991
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,886 0001601813564 1901071406950002
4016
Sumandi
ANAK
01/06/1995
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,887 0001601813575 1901071909050002
4016
Ilham Kurniawan
ANAK
19/09/2005
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,888 0001601813586 1901070910760004
4021
Saifurrahman
PESERTA
09/10/1976
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,889 0001601813597 1901074604730004
4021
Nurjanah
ISTRI
06/04/1973
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,890 0001601813608 1901075910960002
4021
Ovi Nusela
ANAK
19/10/1996
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,891 0001601813619 1901075411100002
4021
Silvia
ANAK
14/11/2010
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,892 0001601813621 1901076007130002
4021
Raisya Ramadhani
ANAK
20/07/2013
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,893 0001601813632 1901075812630001
4026
Roaiti
PESERTA
18/12/1963
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,894 0001601813643 1901070204900001
4026
Aripin
ANAK
02/04/1990
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 126 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,895 0001601813654 1901070201000002
4026
Hendra
ANAK
02/01/2000
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,896 0001601813665 1901070307900002
4031
Tami
PESERTA
03/07/1990
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,897 0001601813676 1901072503680002
4033
Ika
PESERTA
25/03/1968
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,898 0001601813687 1901076008750002
4033
Seliho
ISTRI
20/08/1975
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,899 0001601813698 1901076901960003
4033
Asma
ANAK
29/01/1996
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,900 0001601813709 1901076901980004
4033
Syaroh
ANAK
29/01/1998
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,901 0001601813711 1901072911000003
4033
Sadam
ANAK
29/11/2000
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,902 0001601813722 1901074107340002
4033
Hj. Cik Isah
TAMBAHAN
01/07/1934
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,903 0001601813733 1901070111730002
4039
Razak
PESERTA
01/11/1973
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,904 0001601813744 1901074510790002
4039
Herawati
ISTRI
05/10/1979
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,905 0001601813755 1901076712990002
4039
Nadiya
ANAK
27/12/1999
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,906 0001601813766 1901071703460001
4042
Kemas
PESERTA
17/03/1946
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,907 0001601813777 1901074309520002
4042
Hotimah
ISTRI
03/09/1952
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,908 0001601813788 1901076202960003
4042
Jamiah
ANAK
22/02/1996
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,909 0001601813799 1901074507640004
4045
Hj. Hotiah
PESERTA
05/07/1964
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,910 0001601813801 1901071101810001
4045
yusuf
ANAK
11/01/1987
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,911 0001601813812 1901070603900001
4045
Sulai
ANAK
08/03/1990
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,912 0001601813823 1901070507950002
4045
Mulia
ANAK
05/07/1995
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,913 0001601813834 1901070108990002
4045
Marwan
ANAK
01/08/1999
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,914 0001601813845 1901072901840002
4050
Sabari
PESERTA
29/01/1984
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,915 0001601813856 1901075510790001
4050
Yuliana
ISTRI
15/10/1979
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,916 0001601813867 1901075209090001
4050
Septa Mulya
ANAK
12/09/2009
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,917 0001601813878 1901070702140002
4050
Febra alpaqih
ANAK
07/02/2014
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 127 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,918 0001601813889 1901074505720004
4054
Cik ayu
PESERTA
05/05/1972
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,919 0001601813891 1901072507960003
4054
Taka Hartoni
ANAK
25/07/1996
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,920 0001601813902 1901070909990003
4054
Hartaru
ANAK
09/09/1999
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,921 0001601813913 1901071610640001
4057
Jasan
PESERTA
16/10/1964
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,922 0001601813924 1901074704800003
4057
Mis
ISTRI
07/04/1980
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,923 0001601813935 1901072606030002
4057
Fajri
ANAK
26/06/2003
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,924 0001601813946 1901070812720001
4060
Taufik
PESERTA
08/12/1972
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,925 0001601813957 1901075309740002
4060
Murniani
ISTRI
13/09/1974
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,926 0001601813968 1901075503990004
4060
trisianika
ANAK
15/03/1999
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,927 0001601813979 1901076002010002
4060
Maudia
ANAK
20/02/2001
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,928 0001601813981 1901070507870002
4064
Kemas
PESERTA
07/05/1987
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,929 0001601813992 1901076111890001
4064
Tana
ISTRI
21/11/1989
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,930 0001601814003 1901070311070001
4064
Muhammad Dida
ANAK
11/03/2007
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,931 0001601814014 1901071901500002
4067
Jakar
PESERTA
19/01/1950
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,932 0001601814025 1901074805620001
4067
Mariani
ISTRI
08/05/1962
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,933 0001601814036 1901075208540001
4069
Asni
PESERTA
12/08/1954
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,934 0001601814047 1901072102730002
4070
Suhaimi
PESERTA
21/02/1973
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,935 0001601814058 1901074811810002
4070
Roiyani
ISTRI
11/08/1981
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,936 0001601814069 1901074811810003
4070
Siska Citra Dewi
ANAK
11/08/1981
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,937 0001601814071 1901072905060001
4070
Rahmat Buhori
ANAK
29/05/2006
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,938 0001601814082 1901071702700001
4074
Hasan Harianto
PESERTA
17/02/1970
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,939 0001601814093 1901075010660002
4074
Kartini
ISTRI
10/10/1966
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,940 0001601814104 1901074703940001
4074
Karmila Sari
ANAK
03/07/1994
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 128 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,941 0001601814115 1901075803000002
4074
Dewi Karlina
ANAK
28/03/2000
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,942 0001601814126 1901076603010001
4074
Mita Reskiana
ANAK
16/03/2001
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,943 0001601814137 1901076907060002
4074
Reva Restiana
ANAK
29/07/2006
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,944 0001601814148 1901070109560004
4080
Nasir
PESERTA
01/09/1956
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,945 0001601814159 1901075204700001
4080
Sauni
ISTRI
12/04/1970
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,946 0001601814161 1901070107900025
4080
Sukaria
ANAK
01/07/1990
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,947 0001601814172 1901072507950002
4080
Mirul
ANAK
25/07/1995
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,948 0001601814183 1901075707010001
4080
Susmini
ANAK
17/07/2001
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,949 0001601814194 1901075707070001
4080
Nur Lesa
ANAK
17/07/2006
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,950 0001601814205 1607040406810003
4086
Kholiq mawardi
PESERTA
04/06/1981
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,951 0001601814216 1901076404850001
4086
Susnawati
ISTRI
24/04/1985
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,952 0001601814227 1901071312120003
4086
Muhammad Khorunnia'm
Almawardi
ANAK
13/12/2012
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,953 0001601814238 1901070106540003
4089
Saman
PESERTA
01/06/1954
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,954 0001601814249 1901075210860004
4089
Widia
ANAK
12/10/1986
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,955 0001601814251 1901070512870001
4089
Deni
ANAK
05/12/1987
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,956 0001601814262 1901071411079459
4089
Uci
ANAK
22/01/2002
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,957 0001601814273 1901071212520001
4093
Sukardi
PESERTA
12/12/1952
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,958 0001601814284 1901076609880003
4097
Rosinta
PESERTA
26/09/1988
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,959 0001601814295 1901075210440001
4108
Sabaniah
PESERTA
12/10/1944
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,960 0001601814306 1905055208910002
4110
Ismawati
PESERTA
12/08/1991
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,961 0001601814317 1901072202130001
4110
Fhatur Rachman
ANAK
22/02/2013
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,962 0001601814328 1905050905080002
4110
Afgan
ANAK
09/05/2008
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,963 0001601814339 1901077001010001
4114
Kartika
PESERTA
30/01/2001
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 129 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,964 0001601814341 1901072607790001
4115
Herwan
PESERTA
26/07/1979
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,965 0001601814352 1901076707860002
4115
Susanti
ISTRI
27/07/1986
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,966 0001601814363 1901070608040001
4115
Aldi Armansyah
ANAK
08/08/2004
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,967 0001601814374 1901070602110001
4115
M. Riski
ANAK
06/02/2001
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,968 0001601814385 1901072909690003
4119
Damino
PESERTA
29/09/1969
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,969 0001601814396 1901075010700004
4119
Juriah
ISTRI
10/10/1970
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,970 0001601814407 1901074090600002
4119
Tungki Ariwibowo
ANAK
14/09/2006
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,971 0001601814418 1901072005090002
4119
Rivaldo
ANAK
20/05/2009
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,972 0001601814429 1901070108690001
4123
Katimun
PESERTA
01/08/1969
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,973 0001601814431 1901075212720003
4123
Suwiji
ISTRI
12/12/1972
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,974 0001601814442 1901076710970001
4123
Lilik Fadilah
ANAK
27/10/1997
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,975 0001601814453 1901070410000002
4123
M. Hidayatul Mustofa
ANAK
04/10/2000
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,976 0001601814464 1901071507090002
4123
Ahmad safi'i
ANAK
15/07/2009
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,977 0001601814475 1901071105590001
4128
Solihin
PESERTA
11/05/1959
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,978 0001601814486 1901074310640001
4128
Zaharti
ISTRI
03/10/1964
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,979 0001601814497 1901074506020004
4128
Renda Natalia
ANAK
05/06/2002
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,980 0001601814508 1901074103080001
4128
Dela Marsella
ANAK
01/03/2008
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,981 0001601814519 1901021212920004
4132
Faisal
PESERTA
12/12/1992
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,982 0001601814521 1901076606940001
4132
Herlina
ISTRI
25/06/1994
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,983 0001601814532 1901070413120001
4132
RAFHA SYAPUTRA
ANAK
04/12/2012
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,984 0001601814543 1901070107510016
4135
Mansur
PESERTA
01/07/1951
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,985 0001601814554 1905055508680002
4135
Kama
ISTRI
15/08/1968
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,986 0001601814565 1901070606880002
4135
Sugit0
ANAK
06/06/1988
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 130 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
2,987 0001601814576 1901074607590003
4138
Sukarsih
PESERTA
06/07/1959
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,988 0001601814587 1901074201930001
4138
Nursinta
ANAK
02/01/1993
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,989 0001601814598 1901074711560001
4140
Juairiah
PESERTA
07/11/1956
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,990 0001601814609 1901074311500001
4141
Simpa
PESERTA
03/11/1950
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,991 0001601814611 1901075003600023
4142
Roaida
PESERTA
10/03/1960
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,992 0001601814622 1901074302930001
4142
Zera Febrianti
ANAK
03/02/1993
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,993 0001601814633 1901070303060001
4144
Umar
PESERTA
03/03/1960
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,994 0001601814644 1901072111930001
4144
Mardani
ANAK
21/11/1993
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,995 0001601814655 1901075907040001
4144
Serlinda
ANAK
19/07/2004
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,996 0001601814666 1901077012670001
4144
Sarmijaya
TAMBAHAN
30/12/1967
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,997 0001601814677 1901071209640001
4148
Mastam
PESERTA
12/09/1964
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,998 0001601814688 1901074107670020
4149
Hamila
PESERTA
01/07/1967
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
2,999 0001601814699 1901071510870003
4149
Ugan Suganda
ANAK
15/10/1987
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,000 0001601814701 1901075310960001
4149
Ida lasa
ANAK
13/10/1996
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,001 0001601814712 1901070107480010
4152
Abdul Korib
PESERTA
01/07/1948
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,002 0001601814723 1901074107490021
4152
Zainab
ISTRI
01/07/1949
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,003 0001601814734 1901072310910001
4152
Arlan Fardika
ANAK
23/10/1991
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,004 0001601814745 1901020301990001
4155
Sakaria
PESERTA
03/01/1999
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,005 0001601814756 1901071109130002
4155
Davis Albar
ANAK
11/09/2013
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,006 0001601814767 1901070807740001
4157
Jumadi
PESERTA
08/07/1974
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,007 0001601814778 1901076007790003
4157
Anik Dwi Lestari
ISTRI
20/07/1979
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,008 0001601814789 1901071811010001
4157
Dendi Wayu Ramadan
ANAK
18/11/2001
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,009 0001601814791 1901071307030002
4157
Gesang Bagus Yulianto
ANAK
13/07/2003
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 131 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,010 0001601814802 1901072602070002
4157
Iqbal Catur Farisqi
ANAK
26/02/2007
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,011 0001601814813 1901070307730006
4162
Ishak
PESERTA
03/07/1973
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,012 0001601814824 1901074809800001
4162
Daina
ISTRI
08/09/1980
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,013 0001601814835 1901075012010002
4162
Destina
ANAK
10/12/2001
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,014 0001601814846 1901072405080001
4162
Muhamad Aril
ANAK
24/05/2009
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,015 0001601814857 1901070107690008
4166
Abdullah Akil
PESERTA
01/07/1969
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,016 0001601814868 1901074107780020
4166
Nita
ISTRI
01/07/1978
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,017 0001601814879 1901076506960001
4166
Kasmawati
ANAK
25/06/1996
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,018 0001601814881 1901071707570002
4169
Rino Jumantoro
PESERTA
17/07/1956
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,019 0001601814892 1901074202940003
4169
Citra dewi
ANAK
02/02/1994
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,020 0001601814903 1901072201110003
4169
Muhamad Sabirin
ANAK
22/01/2011
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,021 0001601814914 1901052407830001
4172
Nadi
PESERTA
24/07/1983
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,022 0001601814925 1901070706510001
4173
Tunggal
PESERTA
07/06/1951
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,023 0001601814936 1901074503600001
4173
Sumiati
ISTRI
05/03/1960
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,024 0001601814947 1901072905900002
4178
Jumadi Hartono
PESERTA
29/05/1990
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,025 0001601814958 1901071202530001
4182
Syamsudin
PESERTA
12/02/1953
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,026 0001601814969 1901071612950002
4182
Denny Ardiansyah
ANAK
16/12/1995
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,027 0001601814971 1901070606890001
4185
Yahya
PESERTA
06/06/1969
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,028 0001601814982 1901075205710003
4185
Al-Adha
ISTRI
12/05/1971
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,029 0001601814993 1901074702000002
4185
Ulpa Nadira
ANAK
07/02/2000
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,030 0001601815004 1901075812050003
4185
Pipi Kusumanti
ANAK
18/12/2005
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,031 0001601815015 1901070808690003
4189
Romli
PESERTA
08/08/1969
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,032 0001601815026 1901076108680002
4189
Indiani
ISTRI
21/08/1968
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 132 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,033 0001601815037 1901075501040002
4189
Puja Lestari
ANAK
15/01/2004
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,034 0001601815048 1901072610120001
4189
Muhamad Adhari
ANAK
26/10/2012
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,035 0001601815059 1901070703770001
4193
Karmizi
PESERTA
07/03/1977
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,036 0001601815061 1901074206780002
4193
Darpina
ISTRI
02/06/1978
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,037 0001601815072 1901076401990001
4193
Sari Sundari
ANAK
24/01/1999
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,038 0001601815083 1901070707030003
4193
Sipandi
ANAK
07/07/2003
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,039 0001601815094 1901070603500001
4197
Rozali
PESERTA
08/03/1950
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,040 0001601815105 1901074803600001
4197
Rusiah
ISTRI
08/03/1960
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,041 0001601815116 1901070912040002
4197
Mustofa Rusman
ANAK
09/12/2004
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,042 0001601815127 1901070505790002
4200
Waja
PESERTA
05/05/1979
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,043 0001601815138 1905044111830002
4200
Cicah
ISTRI
01/11/1983
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,044 0001601815149 1901071303120001
4200
Erik Pratama Saputra
ANAK
13/03/2012
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,045 0001601815151 1901075906420001
4203
Cik Yah
PESERTA
19/06/1942
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,046 0001601815162 1901071111750001
4204
Asmunir Adisuyono
PESERTA
11/11/1975
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,047 0001601815173 1901075010770003
4204
Satina
ISTRI
10/10/1977
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,048 0001601815184 1901071609020002
4204
Bagus Hermanto
ANAK
16/09/2002
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,049 0001601815195 1901072711420002
4207
Mohidin
PESERTA
27/11/1942
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,050 0001601815206 1901074806500001
4207
Suriati
ISTRI
08/06/1950
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,051 0001601815217 1901070804760001
4207
Musa
ANAK
08/04/1976
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,052 0001601815228 1901071006880004
4207
Sobardi
ANAK
10/06/1988
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,053 0001601815239 1901076609630002
4212
Hartini
PESERTA
15/09/1963
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,054 0001601815241 1901012309710002
4213
Suryadi
PESERTA
23/09/1971
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,055 0001601815252 1901015309980001
4213
Silvia sandi
ISTRI
13/09/1998
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 133 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,056 0001601815263 1901016807030003
4213
Phaloka
ANAK
28/07/2003
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,057 0001601815274 1901014504080002
4213
Zalzabila
ANAK
05/04/2008
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,058 0001601815296 1901071803690001
4220
Lily Suhaili
PESERTA
18/03/1969
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,059 0001601815307 1901076505790001
4220
Saimah
ISTRI
25/05/1979
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,060 0001601815318 1901071609990003
4220
Budi Saputra
ANAK
16/09/1999
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,061 0001601815329 1901076805000003
4220
Putri Utiti
ANAK
28/05/2000
RIAU SILIP
01/01/2015
AKTIF
19,225
30/12/2014
3,062 0001601815331 1801131103690004
4224
Hasmar Pulungan
PESERTA
03/11/1969
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,063 0001601815342 1801136611720002
4224
Masdinar Bolu Siregar
ISTRI
26/11/1972
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,064 0001601815353 1801134609010004
4224
Nur nyaini
ANAK
09/06/2001
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,065 0001601815364 1801132202030004
4224
Al Malik
ANAK
22/02/2003
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,066 0001601815375 1801131810090003
4224
Riski Nyata
ANAK
18/10/2009
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,067 0001601815386 1901050708880002
4229
Acmad Adindy
PESERTA
07/09/1988
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,068 0001601815397 1901056807880032
4229
Julia
ISTRI
28/07/1989
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,069 0001601815408 1901056405090001
4229
Maycharla Qinayah
ANAK
24/05/2009
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,070 0001601815419 1901051805130003
4229
Abiyyu Shinobi
ANAK
18/05/2013
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,071 0001601815421 1901053004800002
4233
Lie Se Tjung
PESERTA
30/04/1980
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,072 0001601815432 1901057001790005
4233
Sun Ay
ISTRI
30/01/1979
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,073 0001601815443 1901054606040005
4233
Clara Vellencia
ANAK
06/06/2004
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,074 0001601815454 1901056612070001
4233
Natasya Cristina
ANAK
26/12/2007
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,075 0001601815465 1901055501770002
4238
Sumarni
PESERTA
25/01/1977
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,076 0001601815476 1901051711010002
4238
Haykal Okt Afiansyah
ANAK
17/10/2011
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,077 0001601815487 1901051712010002
4238
Rafa Deza Ghafary
ANAK
12/03/2012
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,078 0001601815498 1901051408710003
4241
Tjoeng Sin
PESERTA
14/08/1971
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 134 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,079 0001601815509 1901054506830003
4241
Ira Wanti
ISTRI
06/05/1983
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,080 0001601815511 1901052911020003
4241
Stefan Aldi
ANAK
29/11/2002
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,081 0001601815522 1901054906050002
4241
Felicia Angelia Aldi
ANAK
06/09/2005
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,082 0001601815533 1901050412800003
4246
Andika
PESERTA
12/04/1980
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,083 0001601815544 1901056208770001
4246
Mie Mei
ISTRI
22/08/1977
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,084 0001601815555 1901054202030002
4246
Alvariza
ANAK
02/02/2003
PEMALI
01/01/2015
AKTIF
19,225
30/12/2014
3,085 0001601815566 1901081605690001
4250
Saryanto
PESERTA
16/05/1969
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,086 0001601815577 1901085302710001
4250
Sakniah
ISTRI
13/02/1971
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,087 0001601815588 1901080612510001
4252
Jamal
PESERTA
06/12/1951
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,088 0001601815599 1901086303550001
4252
Sauyah
ISTRI
23/03/1955
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,089 0001601815601 1901080505900003
4252
Juanda
TAMBAHAN
05/05/1990
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,090 0001601815612 1901081307450001
4255
Kudir
PESERTA
13/07/1945
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,091 0001601815623 1901084703500001
4255
Cikni
ISTRI
07/03/1950
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,092 0001601815634 1901081107550002
4257
Amit
PESERTA
11/07/1955
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,093 0001601815645 1901081202940002
4257
Syarif
ANAK
12/02/1994
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,094 0001601815656 1901081006650001
4260
Mahada
PESERTA
10/06/1965
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,095 0001601815667 1901084612740001
4260
Nurbaya
ISTRI
06/12/1974
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,096 0001601815678 1901081010900006
4260
Ashar
ANAK
10/10/1990
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,097 0001601815689 1901080902020003
4260
Pajar
ANAK
09/02/2002
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,098 0001601815691 1901080303030002
4260
Wawan
ANAK
03/03/2003
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,099 0001601815702 1901080609650002
4265
Idrus
PESERTA
06/09/1965
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,100 0001601815713 1901084107620007
4265
Arbi
ISTRI
01/07/1962
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,101 0001601815724 1901080412960005
4265
Ahmad Zakki
ANAK
04/12/1996
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 135 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,102 0001601815735 1901081210680001
4269
Supri
PESERTA
12/10/1968
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,103 0001601815746 1901081511940001
4269
Imam Soleh
ANAK
15/11/1994
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,104 0001601815757 1901084805970001
4269
Siti Roziah
ANAK
08/05/1997
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,105 0001601815768 1901082306030002
4269
Hazuan
ANAK
23/06/2003
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,106 0001601815779 1901080107440005
4269
Umar
TAMBAHAN
01/07/1944
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,107 0001601815781 1901084909680002
4274
Salminah
PESERTA
09/09/1968
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,108 0001601815792 1901081506880004
4274
Jaka Erandi
ANAK
15/06/1988
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,109 0001601815803 1901082306990003
4274
Rudiansyah
ANAK
23/06/1999
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,110 0001601815825 1901081710640001
4279
Suhaili
PESERTA
17/10/1964
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,111 0001601815836 1901084803670001
4279
Sirah
ISTRI
08/03/1967
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,112 0001601815847 1901081407900002
4279
Andiyansyah
ANAK
14/07/1990
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,113 0001601815858 1901085406930002
4279
Sutiana
ANAK
14/06/1993
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,114 0001601815869 1901080110010001
4279
Ijal Darussalam
ANAK
01/10/2001
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,115 0001601815871 1901084806560003
4284
Surni
PESERTA
08/06/1956
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,116 0001601815882 1901080807730001
4284
Kardi
ANAK
08/07/1973
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,117 0001601815893 1901081110500001
4286
Djupri
PESERTA
11/10/1950
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,118 0001601815904 1901084611550001
4286
Saini
ISTRI
06/11/1953
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,119 0001601815915 1901080505590001
4288
Ademi
PESERTA
05/05/1959
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,120 0001601815926 1901085512560001
4288
Rosiah
ISTRI
15/12/1956
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,121 0001601815937 1901082703900006
4288
Su'ud
ANAK
27/03/1956
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,122 0001601815948 1901084807560002
4291
Ngatini
PESERTA
08/07/1956
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,123 0001601815959 1901082602780001
4292
Marsik
PESERTA
26/02/1978
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,124 0001601815961 1901085107800001
4292
Yati
ISTRI
11/07/1980
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 136 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,125 0001601815972 1901084803000001
4292
Latifah
ANAK
08/03/2000
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,126 0001601815983 1901080202050001
4292
Romlan
ANAK
02/02/2005
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,127 0001601815994 1901080311510007
4296
Ibad
PESERTA
03/11/1951
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,128 0001601816005 1901084701570008
4296
Kaisimah
ISTRI
07/01/1957
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,129 0001601816016 1901085703670001
4298
Pahima
PESERTA
17/03/1967
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,130 0001601816027 1901084705660001
4299
Asmi
PESERTA
07/05/1966
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,131 0001601816038 1901084908920001
4299
Sundari
ANAK
09/08/1992
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,132 0001601816049 1901080504960004
4299
Supriadi
ANAK
03/04/1996
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,133 0001601816051 1901084609990001
4299
Mariana
ANAK
06/09/1999
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,134 0001601816062 1901085510010001
4299
Manila
ANAK
15/10/2001
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,135 0001601816073 1901080908660001
4304
Sopian
PESERTA
09/08/1966
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,136 0001601816084 1901084707660001
4304
Asni
ISTRI
07/07/1966
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,137 0001601816095 1901086904900002
4304
Sutia
ANAK
01/07/1990
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,138 0001601816106 1901080308960001
4304
Irfan
ANAK
03/08/1996
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,139 0001601816117 1901084107440008
4308
Romiah
PESERTA
01/07/1944
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,140 0001601816128 1901084107770012
4308
Rominah
ANAK
01/07/1977
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,141 0001601816139 1901085706670001
4310
Sakdiah
PESERTA
17/06/1967
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,142 0001601816141 1901084707940002
4310
wilda
ANAK
07/07/1994
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,143 0001601816152 1901081402590001
4312
Mat Ali
PESERTA
14/02/1959
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,144 0001601816163 1901080107980018
4312
Dandi
ANAK
01/07/1998
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,145 0001601816174 1901080107610008
4314
Maslun
PESERTA
01/07/1961
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,146 0001601816185 1901085401640001
4314
Hasiah
ISTRI
14/01/1964
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,147 0001601816196 1901081002870004
4314
Rahayu
ANAK
06/09/1994
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 137 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,148 0001601816207 1901084609940001
4314
Ardiansyah
ANAK
13/06/2003
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,149 0001601816218 1901081306030001
4314
Tinah
TAMBAHAN
01/07/1929
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,150 0001601816229 1901081505680003
4319
Junaidi
PESERTA
15/05/1968
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,151 0001601816231 1901084410680001
4319
Aida
ISTRI
04/10/1968
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,152 0001601816242 1901081412990001
4319
Aldo Iriansyah
ANAK
14/12/1999
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,153 0001601816253 1901080804030001
4319
Riski Resdia
ANAK
08/04/2003
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,154 0001601816264 1901081208730001
4323
Samsudin
PESERTA
12/08/1973
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,155 0001601816275 1901086512780002
4323
Semah
ISTRI
25/12/1978
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,156 0001601816286 1901085010960003
4323
Damayanti
ANAK
10/10/1996
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,157 0001601816297 1901085007030002
4323
Indah Febriyanti
ANAK
10/07/2003
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,158 0001601816308 1901080411880001
4327
M. Hadori
PESERTA
04/11/1988
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,159 0001601816319 1901085506890003
4327
Leni
ISTRI
15/06/1989
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,160 0001601816321 1901080612090001
4327
Dendra Al Akbar
ANAK
06/12/2009
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,161 0001601816332 1901082904690001
4330
Sopiyanto
PESERTA
29/04/1969
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,162 0001601816343 1901084609740002
4330
Tatik Gunawati
ISTRI
06/09/1974
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,163 0001601816354 1901082107940001
4330
Subandi
ANAK
21/07/1994
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,164 0001601816365 1901082109990001
4330
Gusdur Sumadi
ANAK
21/09/1999
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,165 0001601816376 1901081012490001
4334
Dahlan
PESERTA
10/12/1949
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,166 0001601816387 1901084703580001
4334
Juma'ah
ISTRI
07/03/1956
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,167 0001601816398 1901085405000002
4334
Sulisnawati
ANAK
14/06/2000
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,168 0001601816409 1901080207830002
4337
Arab
PESERTA
02/07/1983
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,169 0001601816411 1901084711860001
4337
Mirnawati
ISTRI
07/11/1986
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,170 0001601816422 1901082606060003
4337
Muhammad Arbit Alfarisi
ANAK
28/06/2006
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 138 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,171 0001601816433 1901081207560001
4340
Hendri
PESERTA
12/07/1956
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,172 0001601816444 1901084208620008
4340
Tini
ISTRI
02/08/1962
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,173 0001601816455 1901081001890001
4340
Dadang Armada
ANAK
10/01/1989
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,174 0001601816466 1901080705900008
4340
Boni Rantau
ANAK
07/05/1990
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,175 0001601816477 1901080307940009
4340
Damon
ANAK
03/07/1994
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,176 0001601816488 1901061310940001
4345
Heri
PESERTA
13/10/1992
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,177 0001601816499 1901084311940003
4345
Tirana Kapita
ISTRI
03/11/1994
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,178 0001601816501 1901081406120001
4345
Raka Ravinza
ANAK
14/06/2012
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,179 0001601816512 1901081110840002
4348
Andriansyah
PESERTA
11/10/1984
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,180 0001601816523 1901084709860003
4348
Nilam
ISTRI
07/09/1986
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,181 0001601816534 1901082311040002
4348
Rian Kaspari
ANAK
23/11/2004
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,182 0001601816545 1901080207110001
4348
Johan Pernandes
ANAK
02/07/2011
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,183 0001601816556 1901084107260001
4348
Ranim
TAMBAHAN
01/07/1928
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,184 0001601816567 1901080705950002
4353
Toni
PESERTA
07/05/1951
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,185 0001601816578 1901080702570002
4353
Bujang Saldi
TAMBAHAN
07/02/1957
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,186 0001601816589 1901086809610001
4353
Solnah
TAMBAHAN
28/09/1961
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,187 0001601816591 1901080609549001
4356
Usman
PESERTA
06/09/1954
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,188 0001601816602 1901084603650002
4356
Bayu
ISTRI
06/03/1965
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,189 0001601816613 1901080209360001
4358
Asni
PESERTA
02/09/1936
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,190 0001601816624 1901081506510001
4359
Ishak
PESERTA
15/06/1951
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,191 0001601816635 1901084111540002
4359
Sauni
ISTRI
01/11/1954
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,192 0001601816646 1901080702560001
4361
Basri
PESERTA
07/02/1956
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,193 0001601816657 1901084409580001
4361
Ropiah
ISTRI
04/09/1958
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 139 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,194 0001601816668 1901080101540003
4363
Serudin
PESERTA
01/01/1954
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,195 0001601816679 1901408671255001
4363
Rebak
ISTRI
27/12/1955
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,196 0001601816681 1901082403710001
4365
Nangcik
PESERTA
24/03/1971
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,197 0001601816692 1901084305740002
4365
Sumarni
ISTRI
03/05/1974
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,198 0001601816703 1901080212940001
4365
Kasandra
ANAK
12/12/1994
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,199 0001601816714 1901083103970001
4365
Mardiansyah
ANAK
31/03/1997
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,200 0001601816725 1901081509050001
4365
Dion Kurniawan
ANAK
15/09/2005
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,201 0001601816736 1901081707780001
4370
Toni
PESERTA
17/07/1978
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,202 0001601816747 1901085307870001
4370
Ratna
ISTRI
13/07/1987
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,203 0001601816758 1901086306100002
4370
Bahijah
ANAK
23/06/2010
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,204 0001601816769 1901086403780002
4373
Maimah
PESERTA
24/03/1938
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,205 0001601816771 1901082708840002
4374
Jumadi
PESERTA
27/08/1984
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,206 0001601816782 1901087006870001
4374
Eka Jayanti
ISTRI
30/06/1987
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,207 0001601816793 1901086403060003
4374
Gea Saskia
ANAK
24/03/2006
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,208 0001601816804 1901080712610001
4377
Hamidi
PESERTA
07/12/1961
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,209 0001601816815 1901084404710007
4377
Jami'ah
ISTRI
04/01/1970
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,210 0001601816826
4377
JONI
ANAK
06/04/1992
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,211 0001601816837 1901086407930011
4377
Silvia
ANAK
05/06/1993
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,212 0001601816848 1901085012990008
4377
Yuliana
ANAK
10/12/1999
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,213 0001601816859 1901084910730003
4382
Rina
PESERTA
09/10/1973
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,214 0001601816861 1901081509570001
4383
Sarpawi
PESERTA
15/09/1957
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,215 0001601816872 1901084708590001
4383
Nuriana
ISTRI
07/08/1959
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,216 0001601816883 1901084308930001
4383
Jamilah
ANAK
03/08/1993
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 140 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,217 0001601816894 1901082105800002
4386
Heri Sukasman
PESERTA
21/05/1980
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,218 0001601816905 1901085505870002
4386
Rusna Meli
ISTRI
21/01/1985
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,219 0001601816916 1901086203040001
4386
Dara Prazhinta
ANAK
22/03/2004
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,220 0001601816927 1901086609070001
4386
Divo Angger Ramadhan
ANAK
26/09/2007
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,221 0001601816938 1901086609070002
4386
Diva Anggun Ramadhani
ANAK
26/09/2007
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,222 0001601816949 1901085307120002
4386
Delta Julia Assefa
ANAK
13/07/2012
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,223 0001601816951 1901080906560001
4392
Zuhri
PESERTA
09/06/1956
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,224 0001601816962 1901084704570001
4392
Hasana
ISTRI
07/04/1957
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,225 0001601816973 1901080606660001
4394
Ependi
PESERTA
07/02/1966
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,226 0001601816984 1901086001560001
4395
Aini
PESERTA
20/01/1956
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,227 0001601816995 1901084107370004
4396
Suryah
PESERTA
01/07/1937
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,228 0001601817006 1901084109790002
4396
Suryama
ANAK
01/09/1979
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,229 0001601817017 1901085601820001
4398
Arun
PESERTA
02/07/1957
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,230 0001601817028 1901080207570002
4398
Aina
ISTRI
11/08/1966
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,231 0001601817039 1901084112380001
4400
Darme
PESERTA
01/07/1940
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,232 0001601817041 1901085110730001
4401
Junaida
PESERTA
11/10/1973
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,233 0001601817052 1901085201780002
4402
Marlina
PESERTA
12/01/1978
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,234 0001601817063 1901080906080001
4402
Nopyansah
ANAK
09/06/2009
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,235 0001601817074 1901080906130002
4402
Muhammad Abizar
ANAK
09/06/2013
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,236 0001601817085 1901081401700001
4407
Rasyidi
PESERTA
14/01/1970
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,237 0001601817096 1901084605750002
4407
Kartini
ISTRI
06/05/1975
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,238 0001601817107 1901086205000002
4407
Melati Sri Wangi
ANAK
22/05/2000
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,239 0001601817118 1901085405040002
4407
Cempaka Fransiska
ANAK
14/05/2004
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 141 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,240 0001601817129 1901082509070001
4407
Aldinar Damar Dinata
ANAK
25/09/2007
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,241 0001601817131 1901081504630011
4412
Subarto
PESERTA
15/04/1963
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,242 0001601817142 1901084503750001
4412
Ropisah
ISTRI
05/03/1975
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,243 0001601817153 1901080101920001
4412
Romlan
ANAK
01/01/1992
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,244 0001601817164 1901084212930001
4412
Nurliza
ANAK
02/12/1993
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,245 0001601817175 1901080702490002
4416
Imron
PESERTA
07/02/1949
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,246 0001601817186 1901084205780001
4416
Hazami
ISTRI
02/05/1978
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,247 0001601817197 1901081602730001
4416
Mashud
TAMBAHAN
16/02/1973
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,248 0001601817208 1901080909040002
4416
Ahmad Tijan
TAMBAHAN
09/09/2004
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,249 0001601817219 1901082010430001
4420
Hozi
PESERTA
20/10/1943
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,250 0001601817221 1901085009530001
4420
Rojemah
ISTRI
10/09/1953
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,251 0001601817232 1901082807840001
4420
Zulkarnain
ANAK
28/07/1985
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,252 0001601817243 1901080401860000
4423
SAFARI
PESERTA
01/04/1986
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,253 0001601817254 1905056011920000
4423
ASMANI
ISTRI
20/11/1992
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,254 0001601817265 1901081011110000
4423
RAMA PRANATA
ANAK
19/11/2011
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,255 0001601817276 1901082603900000
4426
JOHAN
PESERTA
03/09/1990
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,256 0001601817287 1901084811920000
4426
SITI AISYAH
ISTRI
06/11/1992
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,257 0001601817298 1901082109120000
4426
RAFA ALFAKHRIZA
ANAK
21/09/2012
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,258 0001601817309 1901080803840000
4429
SUKRI
PESERTA
27/05/1984
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,259 0001601817311 1901084206880000
4429
ZUBAIDAH
ISTRI
06/02/1988
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,260 0001601817322 1901084612130000
4429
SYAVILA
ANAK
12/06/2013
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,261 0001601817333 1901081002500000
4432
SALDI PRATAMA
PESERTA
02/10/1992
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,262 0001601817344 1901085802130000
4432
ZIPRILIA
ANAK
18/02/2013
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 142 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,263 0001601817355 1901083008870000
4434
ZULPAN
PESERTA
30/08/1987
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,264 0001601817366 1901086003910000
4434
MARYATI
ISTRI
02/10/1992
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,265 0001601817377 1901082412110000
4434
NAZRUL ILHAM
ANAK
24/12/2011
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,266 0001601817388 1901082212840000
4437
AHMAD FIRSADA
PESERTA
22/12/1984
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,267 0001601817399 1901085206900000
4437
ROZAINA
ISTRI
06/12/1990
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,268 0001601817401 1901084204120000
4437
ALEA ZAHRA
ANAK
06/12/1990
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,269 0001601817412 1901081309860000
4440
ROMLAN
PESERTA
13/09/1986
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,270 0001601817423 1901085709670000
4440
ZULAIHA
ISTRI
17/09/1987
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,271 0001601817434 1901080401090000
4440
AHMAD REZA ALGHIFARI
ANAK
01/04/2009
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,272 0001601817445 1901082708900000
4443
DARDI
PESERTA
27/08/1990
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,273 0001601817456 1901084908120000
4443
NAZIFA RAHMADANI
ANAK
08/09/2012
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,274 0001601817467 1901080811740000
4445
MASDAR
PESERTA
11/08/1974
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,275 0001601817478 1901086404770000
4445
MAMA
ISTRI
24/04/1977
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,276 0001601817489 1901086204000000
4445
FERA NURHAZITA
ANAK
22/04/2000
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,277 0001601817491 1901082704040000
4445
FERDIANSYAH
ANAK
27/04/2004
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,278 0001601817502 1901081306130000
4445
FERNANDO ARDIAN
ANAK
13/06/2013
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,279 0001601817513 1901060804880000
4450
SANTUBI
PESERTA
04/08/1988
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,280 0001601817524 1901065609900000
4450
SURIYANI
ISTRI
18/07/1990
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,281 0001601817535 1901064603090000
4450
SITI NURAINI
ANAK
03/06/2009
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,282 0001601817546 1901081204810000
4453
MUHAMMAD DUL HALIM
PESERTA
04/12/1981
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,283 0001601817557 1901085407820000
4453
ROMIYATI
ISTRI
14/07/1982
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,284 0001601817568 1901082602060000
4453
AIDAN SYAIFUDDIN
ANAK
26/02/2006
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,285 0001601817579 1901085105630000
4456
NORMA
PESERTA
05/11/1963
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 143 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,286 0001601817581 1901082107840000
4456
REKI
ANAK
21/07/1984
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,287 0001601817592 1901086408930000
4456
NURHAYATI
ANAK
24/08/1993
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,288 0001601817603 1901081207970000
4456
RINALDI
ANAK
07/12/1997
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,289 0001601817614 1901082607990000
4456
ANDI GHALIB
ANAK
26/07/1999
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,290 0001601817625 1901080701650000
4461
SIDIN
PESERTA
01/07/1965
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,291 0001601817636 1901084107670010
4461
SUMARITA
ISTRI
07/01/1967
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,292 0001601817647 1901085807970000
4461
MELIA
ANAK
18/07/1997
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,293 0001601817658 1901086510080000
4461
KARTIKA PUTRI
ANAK
25/10/2008
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,294 0001601817669 1901080308840000
4465
BUSTAN HARUN
PESERTA
08/03/1984
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,295 0001601817671 1901086107900000
4465
SITI AISYAH
ISTRI
21/07/1990
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,296 0001601817682 1901085409110000
4465
FAIZA FADILA
ANAK
14/09/2011
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,297 0001601817693 1901084107410000
4468
ASIAH
PESERTA
07/01/1941
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,298 0001601817704 3317020906830000
4469
EDY SASMITO
PESERTA
06/09/1983
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,299 0001601817715 1901086401140000
4469
ADHIBAH ALHUSNA
ANAK
24/01/2014
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,300 0001601817726 1901085703450000
4471
SUBAIDAH
PESERTA
17/03/1945
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,301 0001601817737 1901081203890000
4472
SUBANDI
PESERTA
03/12/1989
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,302 0001601817748 1901086209940000
4472
RISKI SUDANA
ISTRI
22/09/1994
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,303 0001601817759 1901080206110000
4472
AHMAD SHOBARI AKBAR
ANAK
06/02/2011
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,304 0001601817761 1905030107610000
4475
ARSAD
PESERTA
07/01/1961
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,305 0001601817772 1901082510890000
4475
ENDI
ANAK
25/10/1989
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,306 0001601817783 1901084601900002
4475
ARPA
ANAK
01/06/1990
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,307 0001601817794 1905031106970000
4475
SUGIRI
ANAK
06/11/1997
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,308 0001601817805 1901082301880000
4479
JUNAINI
PESERTA
23/01/1988
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 144 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,309 0001601817816 1901084412860000
4479
MURNI
ISTRI
12/04/1986
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,310 0001601817827 1901086101100000
4479
NAJWA SALSABILA
ANAK
21/01/2010
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,311 0001601817838 1901082811110000
4479
ALHAFIS
ANAK
28/11/2011
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,312 0001601817849 1901080607680000
4483
MUHAMMAD ASIP
PESERTA
06/07/1968
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,313 0001601817851 1901084304710000
4483
HARTATI
ISTRI
04/03/1971
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,314 0001601817862 1901086504970000
4483
MAITA
ANAK
25/04/1997
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,315 0001601817873 1901083105040000
4483
FERI HARIYANTO
ANAK
31/05/2004
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,316 0001601817884 1901084202120000
4483
ANNISA
ANAK
02/02/2012
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,317 0001601817895 1901066302890000
4488
NUR SYAMSIYAH
PESERTA
23/02/1989
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,318 0001601817906 1901065101110000
4488
AMRINA ROSYADA
ANAK
01/11/2011
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,319 0001601817917 1901081507680000
4490
SADIKIN
PESERTA
15/07/1968
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,320 0001601817928 1901085008690000
4490
SIHAINI
ISTRI
08/10/1969
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,321 0001601817939 1901084201910000
4490
UMI KALSUM
ANAK
12/01/1991
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,322 0001601817941 1901084502930000
4490
DEWI YANTI
ANAK
02/05/1993
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,323 0001601817952 1901081010980000
4490
MIRZAN AULIA
ANAK
10/10/1998
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,324 0001601817963 1901085111070000
4490
MILDA SAFITRI
ANAK
11/11/2007
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,325 0001601817974 1901082304410000
4496
MUHAMMAD
PESERTA
23/04/1941
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,326 0001601817985 1901075004830000
4496
RINI YUNIARTI
ANAK
04/10/1983
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,327 0001601817996 1901076508070000
4496
QURROTA AYUNI
TAMBAHAN
25/08/2007
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,328 0001601818007 1901080307750000
4499
ALYAS
PESERTA
07/03/1975
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,329 0001601818018 1901084107800020
4499
NURAIDA
ISTRI
01/07/1980
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,330 0001601818029 1901082109950000
4499
MUHAMMAD AGUS
ANAK
21/09/1998
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,331 0001601818031 1901084806020000
4499
VIVI ALAIDA
ANAK
06/08/2002
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 145 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,332 0001601818042 1901081908040000
4499
MUHAMMAD IQBAL
ANAK
19/06/2004
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,333 0001601818053 1901080411900000
4504
RAHMATULLAH
PESERTA
11/04/1990
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,334 0001601818064 1901085105120000
4504
NAWRA KHANZA
ANAK
05/11/2012
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,335 0001601818075 1901084107480010
4506
ROBIAH
PESERTA
01/07/1948
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,336 0001601818086 1901080306800000
4506
ABDURRAHMAN
ANAK
03/06/1980
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,337 0001601818097 1901086004840000
4506
TURATI
ANAK
20/04/1984
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,338 0001601818108 1901080509890000
4506
MUHAMMAD SAIPULLAH
ANAK
05/09/1989
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,339 0001601818119 1901080405900000
4510
MAHDI AKBAR
PESERTA
05/04/1990
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,340 0001601818121 1901086202920000
4510
SUSI ERMAWATI
ISTRI
22/02/1992
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,341 0001601818132 1901084805130000
4510
PAYLA ZUNNUR AKBAR
ANAK
05/08/2013
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,342 0001601818143 1901080107920010
4513
JUPRI
PESERTA
07/01/1992
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,343 0001601818154 1901085808910000
4513
AGUSTINI
ISTRI
18/08/1991
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,344 0001601818165 1901086505110000
4513
MEIZA SAPUTRI
ANAK
25/05/2011
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,345 0001601818176 1901085506050000
4513
PITRI
TAMBAHAN
15/06/2005
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,346 0001601818187 1901085304440001
4517
TOHARA
PESERTA
13/04/1944
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,347 0001601818198 1901082508300001
4518
Jaman B.Mas
PESERTA
25/08/1930
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,348 0001601818209 1901081003690002
4518
Samsul Asri
ANAK
10/03/1969
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,349 0001601818211 1901080608760001
4520
Harjo
PESERTA
06/08/1976
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,350 0001601818222 1901085506800005
4520
Rosmini
ISTRI
15/06/1968
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,351 0001601818233 1901080208100004
4520
Donatu pilardo
ANAK
02/08/2001
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,352 0001601818244 1901085009060001
4520
Sintia Rahelia
ANAK
10/09/2006
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,353 0001601818255 1901081209810001
4524
Harjana
PESERTA
12/09/1981
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,354 0001601818266 1901084908820001
4524
Herawati
ISTRI
09/08/1982
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 146 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,355 0001601818277 1901083110020002
4524
Ricky Muhammad Agus
ANAK
31/10/2002
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,356 0001601818288 1901086409120001
4524
Rifka Indah Safira
ANAK
24/09/2012
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,357 0001601818299 1901081111880002
4528
Asianto
PESERTA
11/11/1988
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,358 0001601818301 1901085601960001
4528
Dwi Sulastri
ISTRI
16/01/1996
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,359 0001601818312 1901080203900001
4530
Subari
PESERTA
02/03/1990
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,360 0001601818323 1901086308910003
4530
Muria
ISTRI
23/08/1991
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,361 0001601818334 1901080905130001
4530
BimA Pratama
ANAK
09/05/2013
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,362 0001601818345 1901084810630002
4533
Hotijah
PESERTA
08/10/1963
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,363 0001601818356 1901083101880002
4533
Muhdi
ANAK
31/01/1988
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,364 0001601818367 1901084704960002
4533
Karmila
ANAK
07/04/1996
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,365 0001601818378 1901085905580001
4536
Armia
PESERTA
19/05/1958
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,366 0001601818389 1901084306510001
4537
Suai
PESERTA
03/06/1951
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,367 0001601818391 1901080201930003
4537
Iswahyudi
ANAK
02/01/1993
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,368 0001601818402 1901085206580001
4539
Horiah
PESERTA
12/06/1958
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,369 0001601818413 1901082912470002
4540
Ahjad
PESERTA
29/12/1947
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,370 0001601818424 1901085910720001
4540
Halimah
ANAK
19/10/1972
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,371 0001601818435 1901080308690002
4542
Iskandar
PESERTA
03/08/1969
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,372 0001601818446 1901085104700001
4542
Juriah
ISTRI
11/04/1970
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,373 0001601818457 1901080511960002
4542
Suwandi
ANAK
05/11/1996
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,374 0001601818468 1901084901980001
4542
Irawati
ANAK
09/01/1998
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,375 0001601818479 1901084101890003
4546
Suryana
PESERTA
01/01/1989
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,376 0001601818481 1901080305090002
4546
Ryan Kasanovaldi
ANAK
03/05/2009
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,377 0001601818492 1901080503650004
4548
Jarib
PESERTA
05/03/1965
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 147 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,378 0001601818503 1901084107730026
4548
Asmi
ISTRI
01/07/1973
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,379 0001601818514 1901080711990003
4548
Al Muzuar
ANAK
07/11/1999
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,380 0001601818525 1901080107010013
4548
Asrin
ANAK
01/07/2001
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,381 0001601818536 1901081302120001
4548
Reza arya saputra
ANAK
13/02/2012
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
3,382 0001601825073 1901012002710005
1018
ACHMAD SIDDIQ
PESERTA
20/02/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,383 0001601825084 1901010301610001
1019
POHARJO EFENDY
PESERTA
03/01/1961
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,384 0001601825095 1901015401850002
1019
RITA AVIKA
ISTRI
14/01/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,385 0001601825106 1901013011000004
1019
ANDI YUTIKO
ANAK
30/11/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,386 0001601825117 1901011901770002
1022
MERSIANTO
PESERTA
19/01/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,387 0001601825128 1901014404770006
1022
ROSTINA
ISTRI
04/04/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,388 0001601825139 1901010803060001
1022
MUHAMMAD IQBAL PATIH
ANAK
08/03/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,389 0001601825141 1901011407130002
1022
MUHAMMAD RECHAN AL
HASBY
ANAK
14/07/2013
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,390 0001601825152 1901010406800002
1026
DASLIM
PESERTA
04/06/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,391 0001601825163 1901016103810002
1026
HENNY
ISTRI
21/03/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,392 0001601825174 1901011204850007
1030
SUSY ERYANI
PESERTA
12/04/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,393 0001601825207 1901012607570004
1033
TONY
PESERTA
26/07/1957
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,394 0001601825218 1901015008810003
1033
NINING KURNESIH
ISTRI
10/08/1961
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,395 0001601825229 1901016505660002
1035
EMEH
PESERTA
25/05/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,396 0001601825231 1901011001820005
1035
OTONG
ANAK
10/01/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,397 0001601825242 1901010405540001
1037
TJHIN DJIT LIE
PESERTA
04/05/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,398 0001601825253 1901012103570002
1037
TJHIN DJIT PHIN
TAMBAHAN
21/03/1957
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,399 0001601825264 1901014102590001
1039
SARI
PESERTA
01/02/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,400 0001601825275 1901011509970004
1039
SUTIONO
ANAK
15/09/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 148 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,401 0001601825286 1901011004650001
1041
SUHARNIK
PESERTA
10/04/1961
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,402 0001601825297 1901014503610001
1041
MARIAM
ISTRI
05/03/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,403 0001601825308 1708070908880001
1041
SUPRIATIN
ANAK
09/08/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,404 0001601825319 1901015909930004
1041
NIKASARI
ANAK
19/09/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,405 0001601825321 1901012512950005
1041
NATA LAMBARA
ANAK
25/12/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,406 0001601825332 1901010701980023
1041
SUGI HARTONO
ANAK
07/01/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,407 0001601825343 1901014611020003
1041
PUTRI SARI
ANAK
06/11/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,408 0001601825354 1901015904050001
1041
WINDA SARI
ANAK
19/04/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,409 0001601825365 1901016006620006
1049
KUSTIAH
PESERTA
20/06/1962
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,410 0001601825376 1901012865800004
1049
MULYADI
ANAK
28/05/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,411 0001601825387 1901011512890005
1049
MULYONO
ANAK
15/12/1989
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,412 0001601825398 1901012104710004
1052
FIRDAUS
PESERTA
21/04/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,413 0001601825409 1901014704710002
1052
PONIEM
ISTRI
07/04/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,414 0001601825411 1901011604950003
1052
YUDISTIRA JAKA PRATAMA
ANAK
16/04/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,415 0001601825422 1901014108990005
1052
CHOIRUNNISA DWI
AYUNINGRUM
ANAK
01/08/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,416 0001601825433 1901014108110008
1052
ZAHIRA ANUGRAH TRI
ANAK
01/08/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,417 0001601825444 1901012908580001
1057
SUJI
PESERTA
29/08/1958
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,418 0001601825455 1901014804680002
1057
JARMI
ISTRI
08/04/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,419 0001601825466 1901015503930004
1057
SUCI
ANAK
15/03/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,420 0001601825477 1901014202080001
1057
FEBI SUMIARTI
ANAK
02/02/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,421 0001601825488 1901010602670002
1061
TJEN THE KHUN
PESERTA
06/02/1967
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,422 0001601825499 1901015412710003
1061
NG SAK NIE
ISTRI
14/12/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,423 0001601825501 1901010808940009
1061
SUPRIYONO
ANAK
08/08/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 149 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,424 0001601825512 1901011503970005
1061
SUPRIYANTO
ANAK
15/03/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,425 0001601825523 1901010802630002
1065
HAMID EFFENDI
PESERTA
08/02/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,426 0001601825534 1901015902670001
1065
DJAP MUK IN
ISTRI
19/02/1967
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,427 0001601825545 1901011201860002
1065
HENDRA AKMER
ANAK
12/01/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,428 0001601825556 1901012608920002
1065
AGUS SETIAWAN
ANAK
26/08/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,429 0001601825567 1901012505650005
1069
BUDIONO
PESERTA
25/05/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,430 0001601825578 1901014101680012
1069
SRI HANDAYANI
ISTRI
01/01/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,431 0001601825589 1901012702870003
1069
FENDI YUSDIYANTO
ANAK
27/02/1987
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,432 0001601825591 1901011607890004
1069
RIAN HARYANTO
ANAK
16/07/1989
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,433 0001601825602 1901016703630001
1073
LILI SURYANI
PESERTA
27/03/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,434 0001601825613 1901013004790001
1073
EFENDI
ANAK
30/04/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,435 0001601825624 1901014103950001
1073
DEWI RANTI KUSUMA

WARDANI
ANAK
01/03/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,436 0001601825635 1901016003320001
1073
TJHANG SIN JAN
TAMBAHAN
20/03/1932
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,437 0001601825692 1901012205650003
1083
LAI SIN LIONG
PESERTA
22/05/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,438 0001601825703 1901014504650003
1083
SIN MIN
ISTRI
05/04/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,439 0001601825714 1901011701900004
1083
JEFRI
ANAK
17/01/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,440 0001601825725 1901015111050007
1083
NELSA AMELIA
ANAK
11/11/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,441 0001601825736 1901012902800002
1088
AAT SUMARNA
PESERTA
29/02/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,442 0001601825747 1901016001030006
1088
DEA ANANDA
ANAK
20/01/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,443 0001601825758 1901015912100001
1088
CHILA AURELLIA
ANAK
19/12/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,444 0001601825769 1901015010630005
1092
ARAWATI
PESERTA
10/10/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,445 0001601825771 1901016404930001
1092
ALVIA NANDA
ANAK
24/04/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,446 0001601825782 1901016207980004
1092
DINDA SAVIRA
ANAK
22/07/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 150 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,447 0001601825793 1901011212730000
1095
SAHAR
PESERTA
12/12/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,448 0001601825804 1901015212740012
1095
KAMSIA
ISTRI
12/12/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,449 0001601825815 1901010601020006
1095
RIDWAN
ANAK
02/01/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,450 0001601825826 1901012202100002
1095
FAHRI YANSYAH
ANAK
22/02/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,451 0001601825837 1901011304770004
1099
MUJIONO
PESERTA
13/04/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,452 0001601825848 1901014805820002
1099
ISLAMIYAH
ISTRI
08/05/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,453 0001601825859 1901010110030005
1099
ILHAM SAPUTRA
ANAK
01/10/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,454 0001601825861 1901014902110004
1099
NURUL FEBYANTI
ANAK
09/02/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,455 0001601825872 1901012209700002
1103
EKO SANTOSO
PESERTA
22/09/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,456 0001601825883 1901015806750003
1103
SRI REJEKI
ISTRI
18/06/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,457 0001601825894 1901014507990004
1103
PUTRI INDAH LESTARI
ANAK
05/07/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,458 0001601825905 1901011509450002
1107
ADAM SUPARMAN
PESERTA
15/09/1945
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,459 0001601825916 1901014401750003
1107
SRI LESTARI
ISTRI
04/01/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,460 0001601825927 1901015508100003
1107
SRIYANA
ANAK
15/08/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,461 0001601825938 1901014505000002
1107
TRI MURNI
TAMBAHAN
05/05/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,462 0001601825949 1901015910010007
1107
SRI RAHAYU
TAMBAHAN
19/10/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,463 0001601825951 1901011304790001
1112
APRIYUDI
PESERTA
13/04/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,464 0001601825962 1901015705810003
1112
TRI HANDAYANI
ISTRI
17/05/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,465 0001601825973 1901015304070003
1112
SYAVIRA PRATIWI
ANAK
13/04/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,466 0001601825984 1901014103550002
1112
MANI
TAMBAHAN
01/03/1955
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,467 0001601825995 1901016104490002
1116
MASNAH
PESERTA
21/04/1949
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,468 0001601826006 1901014304510002
1117
SUYATMI
PESERTA
03/04/1951
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,469 0001601826017 1901010101700008
1117
SLAMET SUSANTO
ANAK
01/01/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 151 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,470 0001601826028 1901013005770003
1117
SUMADI MS.
ANAK
30/05/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,471 0001601826039 1901010403800004
1120
TONI APRIANTO
PESERTA
04/03/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,472 0001601826041 1901015109820007
1120
SULISIA
ISTRI
11/09/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,473 0001601826052 1901010105010003
1120
EDY SUPIANTO
ANAK
01/05/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,474 0001601826063 1901016507050002
1120
DHEVITA ANANTA
ANAK
25/07/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,475 0001601826074 1901010709110002
1120
MUHAMMAD ERZAN
ANAK
07/09/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,476 0001601826085 1901011202430003
1126
TOHA
PESERTA
12/02/1943
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,477 0001601826096 1671020605850009
1128
ANUAR
PESERTA
06/05/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,478 0001601826107 1671025010840013
1128
MARYAM HERLINA
ISTRI
10/10/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,479 0001601826118 1671021102930006
1128
FAJAR PRATAMA
ANAK
26/08/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,480 0001601826129 1901016509100003
1128
AMELIA SEPTIANI
ANAK
25/09/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,481 0001601826131 1571026203510005
1128
CIK WAN
TAMBAHAN
02/03/1951
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,482 0001601826142 1901011109680005
1140
ASMAR
PESERTA
11/09/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,483 0001601826153 1901015204760005
1140
SITI ZALEHA
ISTRI
12/04/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,484 0001601826164 1901015206960003
1140
ASTI DWI LESTARI
ANAK
12/06/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,485 0001601826175 1901016802000003
1140
FITRIANI BALQIS
ANAK
28/02/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,486 0001601826186 1901012308030003
1140
MUHAMAD SINHU
TERDINSYAH
ANAK
23/08/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,487 0001601826197 1901011107670004
1146
SARBINI
PESERTA
11/07/1967
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,488 0001601826208 1901014410580008
1146
MAISYAROH
ISTRI
04/10/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,489 0001601826219 1901012905990008
1146
RIANDA SAPUTRA
ANAK
29/05/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,490 0001601826221 1901010903010004
1146
ARFIANDI
ANAK
09/03/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,491 0001601826232 1901017110040005
1146
ULAN OKTAVIYANI
ANAK
31/10/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,492 0001601826243 1901011911760003
1155
MUHAMMAD ARIS
PESERTA
19/11/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 152 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,493 0001601826254 1901015006820006
1155
ERNA
ISTRI
10/06/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,494 0001601826265 1901010911010002
1155
MUHAMMAD ANANDA
SAPUTRA
ANAK
09/11/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,495 0001601826276 1901016002060004
1155
SHERINA MAHARANI
ANAK
20/02/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,496 0001601826287 1901016302610002
1159
TJONG SAK LIANG
PESERTA
23/02/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,497 0001601826298 1901015902700003
1159
TJONG A HIE
TAMBAHAN
19/02/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,498 0001601826344 1901016604910004
1167
NURHASANAH
PESERTA
26/04/1991
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,499 0001601834152 1901016607100003
1167
ULPA
ANAK
26/07/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,500 0001601826401 1901011101810003
1177
ERWANTO
PESERTA
11/01/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,501 0001601834242 1901014701830017
1177
MARIAH
ISTRI
07/01/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,502 0001601826423 1901016109030007
1177
INDAH SEPTIANI
ANAK
21/09/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,503 0001601826434 1901015103110001
1177
BAYYINAH YUSYANTI
ANAK
11/03/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,504 0001601826513 1901016705830001
1201
SURAWATI
PESERTA
27/05/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,505 0001601834409 1901011911020001
1201
ALFAREZI RAMADHAN
ANAK
19/11/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,506 0001601826535 1901011803720001
1204
SUNARDI
PESERTA
18/03/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,507 0001601834411 1901016012760001
1204
RESMI PAUZI
ISTRI
20/12/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,508 0001601826557 1901016506020001
1204
SELPIA PEBRIANTI
ANAK
25/06/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,509 0001601826579 1901011407050001
1204
RIZKI SAPUTRA
ANAK
14/07/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,510 0001601826592 1901010405790003
1208
YEES IMPIAN
PESERTA
04/05/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,511 0001601826603 1901016003790003
1208
LISDARNI
ISTRI
20/03/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,512 0001601826625 1901012408060001
1208
FAREL ADRIAN
ANAK
24/08/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,513 0001601834422 1901014504040003
1208
WENDARI PUTRI FATIMAH
ANAK
05/04/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,514 0001601834433 1901015611110002
1208
AISYAH MAESYA ANGGINI
ANAK
16/11/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,515 0001601826647 1901011904390001
1213
ISMAIL
PESERTA
19/04/1939
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 153 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,516 0001601834444 1901014512500002
1213
JAISAH
ISTRI
05/12/1950
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,517 0001601826693 1901010408650001
1223
ZULKARNAIN
PESERTA
04/08/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,518 0001601834512 1901014207700001
1223
ASTUTIANA
ISTRI
02/07/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,519 0001601826715 1901011501690001
1227
JANUAR
PESERTA
15/01/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,520 0001601826737 1901014202040001
1227
ASTRI WAHYUNI
ANAK
02/02/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,521 0001601834523 1901015912980001
1227
DEA SAFITRI
ANAK
19/12/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,522 0001601834534 1901017011070001
1227
SYNA A.YUNING
ANAK
30/11/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,523 0001601826759 1901010608580001
1233
LIDIN
PESERTA
06/08/1958
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,524 0001601834545 1901014407670003
1233
ASNI
ISTRI
04/07/1967
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,525 0001601834556 1901010909910003
1233
ANGGA
ANAK
09/09/1991
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,526 0001601826783 1901015001370001
1237
ASNAH
PESERTA
10/01/1937
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,527 0001601826816 1901014105750006
1241
KURMALASARI
PESERTA
05/05/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,528 0001601826838 1901015806860003
1251
TRI WAHYUNI
PESERTA
18/08/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,529 0001601834591 1901010809850002
1251
FIKKI SATRIA
ANAK
08/09/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,530 0001601834602 1901011702880004
1251
ANGGIH PRALAYA
ANAK
17/02/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,531 0001601826862 1901012704830004
1255
MEGA PRAGANGGA
PESERTA
27/04/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,532 0001601834613 1904034908870002
1255
SRI WAHYUNI
ISTRI
09/08/1987
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,533 0001601826884 1901010208830006
1257
NUNUR ARIFIN
PESERTA
02/08/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,534 0001601826906 1901010708110001
1257
AZRIL ARDIANSYAH
ANAK
07/08/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,535 0001601834624 1901014904080002
1257
PUTRI AFRILIANTI
ANAK
09/04/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,536 0001601826939 1901016002140003
1266
ASIFAH DINDA KINAYAH
PESERTA
20/02/2014
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,537 0001601826996 1901012103780003
1280
SRI EFFENDY
PESERTA
21/03/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,538 0001601834771 1901015505820005
1280
NURLELA
ISTRI
15/05/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 154 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,539 0001601827018 1901016605060005
1280
CUT MAULIZA EFFENDY
ANAK
26/05/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,540 0001601834782 1901014805110001
1280
CUT MEIDITA EFENDY
ANAK
08/05/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,541 0001601827053 1901014511800001
1288
HANIFAH
PESERTA
05/11/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,542 0001601834826 1901010202930001
1288
TURMUDI
ANAK
02/02/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,543 0001601827075 1901012308700004
1290
KURLIANTO
PESERTA
23/08/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,544 0001601827086 1901014411750007
1290
NURHAYATI
ISTRI
04/11/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,545 0001601827108 1901012010970001
1290
TITO SAMONTRI
ANAK
20/10/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,546 0001601827119 1901012612980004
1290
HEKY KURNIADI
ANAK
26/12/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,547 0001601834837 1901016406930003
1290
LIDYA KRISYAWITA
ANAK
24/06/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,548 0001601834848 1901015906000003
1290
MEISI LILA FATHIAN
ANAK
19/06/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,549 0001601827132 3528090107760145
1296
ABD. HALIM
PESERTA
08/07/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,550 0001601827154 3528094106990003
1296
HATIMAH
ISTRI
01/07/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,551 0001601827176 3528094107800095
1296
NAFIAH
ANAK
21/02/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,552 0001601834859 3528096102020001
1296
ROHMA
ANAK
01/06/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,553 0001601827209 1901011010890020
1306
SANTO SETIADI
PESERTA
10/10/1989
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,554 0001601827222 1901014305880011
1306
SARTIKA
ISTRI
03/05/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,555 0001601834894 1901016310080003
1306
CALLISTA OKTAVIANI
ANAK
23/10/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,556 0001601827244 1901014103620004
1309
ASMARA
PESERTA
01/03/1962
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,557 0001601827266 1901011706930002
1309
HARIAN
ANAK
17/03/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,558 0001601834905 1901011908810003
1309
ARI ANGGARA
ANAK
19/08/1987
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,559 0001601827299 1901013112810005
1316
DOFIR
PESERTA
31/12/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,560 0001601834951 1901011204100003
1316
JA'FAR SODIQ
ANAK
12/04/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,561 0001601827312 1901014304140002
1321
RAHELIA AMANDA
PESERTA
03/04/2014
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 155 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,562 0001601827323 1901011105560003
1322
KUWAT
PESERTA
11/05/1956
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,563 0001601834962 1901014407590003
1322
SANIATI
ISTRI
04/07/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,564 0001601827345 1901010501810008
1322
DIDI WAHYUDI
ANAK
05/01/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,565 0001601834973 1901010608890005
1322
SELAMAT RIYADI
ANAK
06/08/1989
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,566 0001601827367 1901011105830006
1326
JUNAIDI
PESERTA
11/05/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,567 0001601834984 1901014804840006
1326
WIDARTI
ISTRI
08/04/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,568 0001601827389 1901014312040006
1326
EKA ESTIA NINGRUM
ANAK
03/12/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,569 0001601834995 1901012608110005
1326
IBNU ROMADHAN
ANAK
28/08/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,570 0001601827402 1901011402780007
1330
MARHAJI
PESERTA
14/02/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,571 0001601827435 1901011708860010
1335
MUHSIN
PESERTA
17/08/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,572 0001601835039 1901015206850010
1335
UMI FAJRIANI
ISTRI
12/06/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,573 0001601827457 1901011808080004
1335
SAYYIDUL AKBAR
ANAK
18/08/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,574 0001601835041 1901011709130002
1335
MUHAMMAD FACHRILLAH
ANAK
17/09/2013
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,575 0001601827479 1901012106800003
1339
HAMZAH
PESERTA
21/06/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,576 0001601835052 1901014803830003
1339
HATI SUPITA
ISTRI
08/03/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,577 0001601827492 1901014401040001
1339
ZIMA AZHARI
ANAK
04/01/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,578 0001601835063 1901011504070001
1339
RASYA PRATAMA
ANAK
15/04/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,579 0001601827514 1901010510860004
1343
IPANDI
PESERTA
05/10/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,580 0001601835074 1901014205890008
1343
ANITA
ISTRI
02/05/1989
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,581 0001601827536 1901011406070006
1343
RAFI PRATAMA
ANAK
14/06/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,582 0001601835085 1901012607130001
1343
NAZARI RAMADHAN
ANAK
26/07/2013
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,583 0001601827558 1901010909780005
1347
TUKINO
PESERTA
09/09/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,584 0001601835096 1901014110880005
1347
TASRIAH
ISTRI
01/10/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 156 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,585 0001601827571 1901012012060005
1347
JOKO ALI
ANAK
20/12/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,586 0001601835107 1901014108110006
1347
AYU WULANDARI
ANAK
01/08/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,587 0001601827593 1901011007730002
1351
SUTAN
PESERTA
10/07/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,588 0001601835118 1901015405750005
1351
YUNIAR
ISTRI
14/05/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,589 0001601827626 1901015709990002
1351
SUSANTI
ANAK
17/09/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,590 0001601835129 1901014410970002
1351
YUNI HERNITA
ANAK
04/10/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,591 0001601835131 1901011704110001
1351
FATHAN MUHAMAD RIZKIY
ANAK
17/04/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,592 0001601827648 1901011308840002
1356
SUNDRA
PESERTA
13/08/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,593 0001601835142 1901014506840003
1356
DINA
ISTRI
05/06/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,594 0001601827672 1901014403080003
1356
KIKEN KASANDRA
ANAK
04/03/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,595 0001601835153 1901015105040003
1356
STEPY DEPRIANI
ANAK
11/05/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,596 0001601827705 1901016105740005
1364
NURIA
PESERTA
21/05/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,597 0001601835197 1901015705010003
1364
SITI SUMARNI
ANAK
17/05/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,598 0001601827727 1901011604530002
1366
BUN KONG TJAI
PESERTA
16/04/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,599 0001601835208 1901014108600003
1366
NG YUK LAN
ISTRI
01/08/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,600 0001601827749 1901011901850004
1366
TRI YANTO
ANAK
19/01/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,601 0001601835219 1901016509860002
1366
KAMERINA
ANAK
25/09/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,602 0001601827762 1901012903070003
1372
MUHAMMAD SODIKIN
PESERTA
29/03/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,603 0001601827817 1901010310680001
1383
IRMAN L
PESERTA
03/10/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,604 0001601827828 1901014102750004
1383
BISMIATI
ISTRI
01/02/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,605 0001601835311 1901011703060003
1383
MOHAMMAD FARID FOUZAN
ANAK
17/03/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,606 0001601835322 1901015811090001
1383
CUT MUTIA
ANAK
18/11/2009
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,607 0001601827852 1901011512630002
1387
ERWAN
PESERTA
15/12/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 157 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,608 0001601835333 1901016309650002
1387
ELI EKA SUMI
ISTRI
23/09/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,609 0001601835344 1901014906960002
1387
YULI ARYA AMARA
ANAK
09/06/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,610 0001601827885 1901016007470001
1390
TJHIA HIAN MOI
PESERTA
20/07/1947
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,611 0001601827918 1901016506740002
1397
BOEN NGIT TJIU
PESERTA
25/06/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,612 0001601827929 1901011301580004
1398
TJHIN MOEK TJHON
PESERTA
13/01/1958
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,613 0001601835401 1901016801660003
1398
BUN LIE FA
ISTRI
28/01/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,614 0001601827942 1901012610920003
1398
KURNIAWAN
ANAK
26/10/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,615 0001601827953 1901011909800002
1401
KAIDI
PESERTA
19/09/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,616 0001601827975 1901015007790007
1401
SYALBIAH
ISTRI
10/07/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,617 0001601828008 1901011110120004
1401
REZKY TRI SAPUTRA
ANAK
11/10/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,618 0001601835412 1901011306020009
1401
RAJA SAPUTRA
ANAK
13/06/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,619 0001601835423 1901016907060006
1401
INTAN FRISTI WULANDARI
ANAK
29/07/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,620 0001601828019 1901012205820001
1406
WINDRA KUSUMA
PESERTA
22/05/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,621 0001601828021 1901014210790002
1406
MERRI
ISTRI
02/10/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,622 0001601828043 1901012308120002
1406
AGUSTI PRIANANDA
ANAK
23/08/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,623 0001601835434 1901015609040002
1406
DEVITA PRATIWI
ANAK
16/09/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,624 0001601828065 1901071411660002
1411
HENDI ZULKARNAIN
PESERTA
14/11/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,625 0001601835456 1901014612910012
1411
RASINTA
ISTRI
06/12/1991
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,626 0001601828087 1901015711100003
1411
MUZALIFA
ANAK
17/11/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,627 0001601828109 1901012104780001
1420
ANWAR SADAT
PESERTA
21/04/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,628 0001601835489 1901014606810001
1420
ZAINA
ISTRI
06/06/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,629 0001601828122 1901010903010002
1420
RAKA ADI BASKARA
ANAK
09/03/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,630 0001601828144 1901010610060004
1420
REZA RAMADANI
ANAK
06/10/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 158 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,631 0001601828223 1901011205630010
1442
MININ
PESERTA
12/05/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,632 0001601835636 1901015004650003
1442
ASIDAH
ISTRI
10/04/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,633 0001601828267 1901011908690005
1449
AULIA KUSUMA NEGARA
PESERTA
19/08/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,634 0001601835682 1901014605700005
1449
SUMARNI
ISTRI
06/05/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,635 0001601828289 1901011308030001
1449
ADAM MAULANA
ANAK
13/08/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,636 0001601835693 1901012308060006
1449
ABI NASRALLAH
ANAK
23/08/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,637 0001601828302 1674011205810009
1454
RAYADI
PESERTA
12/06/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,638 0001601835704 1901014101950009
1454
SUSI SUSTRIYANI
ISTRI
01/01/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,639 0001601828324 1901011007120001
1454
RAGEL SUADI
ANAK
10/07/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,640 0001601828392 1901012701770002
1462
EDY RUSMAN
PESERTA
27/01/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,641 0001601835737 1901014502780002
1462
JULITA
ISTRI
05/02/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,642 0001601828414 1901011108980002
1462
AGUSTIAWAN
ANAK
11/08/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,643 0001601835748 1901011008040004
1462
ANGGI PRAMANA
ANAK
10/08/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,644 0001601828436 1901010106820007
1466
ABI MANYU
PESERTA
01/06/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,645 0001601835759 1901015507900004
1466
LIA YULIANA
ISTRI
15/07/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,646 0001601828458 1901010301060001
1466
ARIFIN BUDIMAN
ANAK
03/01/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,647 0001601835761 1901016607100001
1466
SABILA PUTRI NUR AMALIA
ANAK
26/07/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,648 0001601828471 1607142304760003
1470
AHMAD ROFINGI
PESERTA
25/04/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,649 0001601835772 1607144603820002
1470
KRISTIN PRASETIYO
ISTRI
05/03/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,650 0001601828493 1607144905030002
1470
NUR KHOIRIYAH
ANAK
09/05/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,651 0001601828504 1607147103110002
1470
DWI KHOIROTUN
ANAK
31/03/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,652 0001601828537 1901014310600001
1477
RUSLAN
PESERTA
03/10/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,653 0001601828559 1901014911640001
1477
ROHAINI
ISTRI
09/11/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 159 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,654 0001601828572 1901011005000002
1477
IFRAN
ANAK
10/05/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,655 0001601835816 1901016212920002
1477
ELGA
ANAK
22/12/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,656 0001601828583 1901012809960004
1481
DWI BEJO WALUYO
PESERTA
28/09/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,657 0001601828594 1901015708940013
1481
ARYENI
ISTRI
17/08/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,658 0001601828616 1901016703140002
1481
AKIFA NAILA
ANAK
27/03/2014
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,659 0001601828627 1901012604830005
1484
ZIRWAN
PESERTA
26/04/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,660 0001601835827 1901016412870003
1484
REKA
ISTRI
24/12/1987
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,661 0001601828649 1901015006080003
1484
ZELLIKA
ANAK
10/06/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,662 0001601835838 1901010108120002
1484
DARMA MAHRIZAN
ANAK
01/08/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,663 0001601828662 1901011308770007
1488
NASPU
PESERTA
13/08/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,664 0001601828673 1901014906830007
1488
ZAITI
ISTRI
09/06/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,665 0001601828684 1901015510000006
1488
DITYA
ANAK
15/10/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,666 0001601835849 1901015904070002
1488
PUTRI SAFITRI
ANAK
19/04/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,667 0001601828706 1901010504490002
1492
ARPAH
PESERTA
25/04/1949
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,668 0001601835851 1901012303920000
1492
YUNIAR
ANAK
23/06/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,669 0001601828728 1805272611670001
1495
SUKARIANTO
PESERTA
25/11/1967
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,670 0001601835862 1805276307760003
1495
SUKIEM
ISTRI
13/07/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,671 0001601828741 1805271307960003
1495
MUSLIM
ANAK
13/07/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,672 0001601828763 1805271705030005
1495
SUTRIS
ANAK
17/05/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,673 0001601828796 1805274611110002
1495
SRI WULANDARI
ANAK
05/11/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,674 0001601828807 1805270601130001
1495
FIRMAN ARDIANSYAH
ANAK
05/01/2013
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,675 0001601835873 1805278509000003
1495
EVA SUSANTI
ANAK
25/09/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,676 0001601835884 1805275112060002
1495
SUSANA
ANAK
11/02/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 160 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,677 0001601835895 1805277031010001
1495
AGUNG SUGIARTO
ANAK
03/10/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,678 0001601828831 1901011008650003
1508
DJUHANA
PESERTA
10/08/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,679 0001601828853 1901014607730002
1508
HERNAWATI
ISTRI
06/07/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,680 0001601828875 1901012611000001
1508
NOVRIANSYAH
ANAK
26/11/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,681 0001601835941 1901012909940002
1508
KOKO KOMALUDIN
ANAK
29/09/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,682 0001601828908 1901011501810001
1515
JUANTAMA
PESERTA
15/01/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,683 0001601828919 1901015009880002
1515
SETI ASIH
ISTRI
10/09/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,684 0001601835985 1901012609080001
1515
RIDHO SEPTINO
ANAK
26/09/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,685 0001601828932 1901011006560001
1518
MAMAN TARMAN
PESERTA
10/06/1956
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,686 0001601835996 1901016707580004
1518
ROSIDAH
ISTRI
27/07/1957
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,687 0001601828954 1901011912020004
1518
EKA PRAYOGA
ANAK
19/12/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,688 0001601828965 1901014203890004
1522
WIMA RELIA
PESERTA
02/03/1989
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,689 0001601836007 1901012005140002
1522
FARIZ ALFARIZY
ANAK
20/05/2014
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,690 0001601828998 1901011506710003
1525
ERNILAWATI
PESERTA
05/06/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,691 0001601829011 1901015605990001
1525
PINA YANTIKA SARI
ANAK
16/05/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,692 0001601836018 1901015208930002
1525
PONIKA PURNAMASARI
ANAK
12/08/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,693 0001601829022 1901015512390001
1529
SAMANI
PESERTA
15/12/1939
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,694 0001601829033 1901014101640004
1531
KARIMAH
PESERTA
01/01/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,695 0001601829055 1901015802930004
1531
FEBRIYANTI
ANAK
18/02/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,696 0001601836029 1901011009850004
1531
M.YANI
ANAK
10/09/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,697 0001601829077 1901012801700003
1534
MUSRIYANTO
PESERTA
28/01/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,698 0001601829099 1901014902740002
1534
ROSDIANI
ISTRI
09/02/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,699 0001601829112 1901012106100002
1534
MUHAMMAD THOHIR
ANAK
21/06/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 161 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,700 0001601836031 1901011612040003
1534
ACHMAD KHOMSYAH
ANAK
16/12/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,701 0001601829178 1901011910700002
1553
HUSAINI
PESERTA
19/10/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,702 0001601836154 1901015111860004
1553
YANTI
ISTRI
11/11/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,703 0001601836165 1901010907120003
1553
YASKURNIA
ANAK
09/07/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,704 0001601829202 1901010304610005
1557
A.SUDRAJAT
PESERTA
03/04/1961
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,705 0001601836176 1901014707680008
1557
OON YUNINGSIH
ISTRI
07/07/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,706 0001601829224 1901015611980005
1557
NOVITRI MULYANI
ANAK
16/11/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,707 0001601829235 1901015612720002
1560
ROSIDAH
PESERTA
16/12/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,708 0001601829246 1901012009930005
1560
SEPTIAN FITRIANSYAH
ANAK
20/09/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,709 0001601836187 1901013012950001
1560
MELGI PRASETYA
ANAK
30/12/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,710 0001601836198 1901016903990002
1560
BELLA OLDINA CAMELA
ANAK
29/03/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,711 0001601829279 1901015012640003
1565
ROPI'AH
PESERTA
10/12/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,712 0001601829292 1901016305760003
1568
RINA
PESERTA
23/05/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,713 0001601829303 1901015910930007
1568
RISKI OKTAVIANI
ANAK
19/10/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,714 0001601829314 1901011801680002
1570
ABDUL MAZRIADI
PESERTA
18/01/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,715 0001601836222 1901015505670003
1570
ROHANI
ISTRI
15/05/1967
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,716 0001601829358 1901013011900002
1570
ALDO MARTINO
ANAK
30/11/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,717 0001601829382 1901014602970002
1570
DONA FERESTA PUTRI
ANAK
06/02/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,718 0001601829404 1901016611080001
1570
ZAHWA NOPIKA
ANAK
26/11/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,719 0001601836233 1901011607880002
1570
ADHA MAHENDRA
ANAK
16/07/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,720 0001601836244 1901012306940002
1570
ANDI MASENO
ANAK
23/06/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,721 0001601836255 1901012107040001
1570
ALZA MAFINDO
ANAK
21/07/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,722 0001601829415 1901012912770001
1582
RIDUAN
PESERTA
29/12/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 162 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,723 0001601836266 1901014708790004
1582
SURYANI
ISTRI
07/08/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,724 0001601829437 1901015705020001
1582
MELINDA
ANAK
17/05/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,725 0001601829448 1901014405110001
1582
MELODI CAESAR PUTRI
ANAK
04/05/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,726 0001601829459 1901010207720003
1586
ROZALI
PESERTA
02/07/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,727 0001601836277 1901015802600002
1586
MARYANTI
ISTRI
18/02/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,728 0001601829472 1901014901000002
1586
FITRI LESTARI
ANAK
09/01/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,729 0001601836288 1901016811040004
1586
NOVA ELIZAH
ANAK
28/11/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,730 0001601829494 1901012511680002
1590
BASRI
PESERTA
25/11/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,731 0001601829505 1901015206730002
1590
ASNAH
ISTRI
12/06/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,732 0001601829538 1901010805010002
1590
FEBIAN ARDIANSYAH
ANAK
08/05/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,733 0001601836299 1901012912930006
1590
FERDIANSYAH PUTRA
ANAK
29/12/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,734 0001601836301 1901012304990002
1590
FERRY KURNIAWAN
ANAK
23/04/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,735 0001601829551 1901011508360002
1596
SANTOSO
PESERTA
15/08/1936
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,736 0001601829562 1901014101410001
1597
FATIMAH
PESERTA
01/01/1941
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,737 0001601829584 1901011805480001
1599
MASDJONO
PESERTA
18/05/1948
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,738 0001601836334 1901015013540001
1599
ASNAH
ISTRI
11/03/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,739 0001601829606 1901012702790003
1599
BUDI
ANAK
27/02/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,740 0001601829617 1901014711930007
1599
SRI CHRISTIANI
ANAK
07/11/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,741 0001601829639 1901010912040005
1599
IRFANI SAFITRAH
ANAK
09/12/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,742 0001601836345 1901010203960001
1599
ADIK SAHPUTRA PURNOMO
ANAK
02/03/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,743 0001601829663 1901011212570006
1609
RASIDI
PESERTA
12/12/1957
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,744 0001601829685 1901015010600009
1609
MARINA
ISTRI
10/10/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,745 0001601836389 1901015211020005
1609
RANI
ANAK
12/11/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 163 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,746 0001601829707 1901011112650003
1612
EDI WANDI
PESERTA
11/12/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,747 0001601836391 1901014702720005
1612
ELLIYANTI
ISTRI
07/02/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,748 0001601829729 1901011603880001
1614
ISMUN SAHRONI
PESERTA
16/03/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,749 0001601836402 1905024411920001
1614
SARTIKA
ISTRI
04/11/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,750 0001601829742 1901011911110002
1614
IKHSAN ALKAUTSAR
ANAK
19/11/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,751 0001601829786 1901012612760008
1621
ABDUL MASRAM DANDIAR
PESERTA
26/12/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,752 0001601829797 1901015212810006
1621
RITA
ISTRI
12/12/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,753 0001601829819 1901012304040002
1621
ANGGA
ANAK
23/04/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,754 0001601836457 1901014760000004
1621
MON CA
ANAK
07/06/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,755 0001601829821 1901013011620003
1626
AHMAD RAMSYAH
PESERTA
30/11/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,756 0001601836468 1901014411660001
1626
KURNIA RESMI
ISTRI
04/11/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,757 0001601829843 1901012712970004
1626
RINGGIT MOHAMMAD DOLAR
ANAK
27/12/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,758 0001601829865 1901015110100004
1626
SASKIA MUTIARA JELITA
ANAK
11/10/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,759 0001601836479 1901010604060002
1626
ARIA ALFARIZY
ANAK
05/04/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,760 0001601829887 1901012206680002
1631
AMON
PESERTA
22/06/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,761 0001601836481 1901014707830009
1631
YULIAWATI
ISTRI
07/07/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,762 0001601829909 1901011107990006
1631
EFAN MAULANA FAJAR S.
ANAK
11/07/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,763 0001601836492 1901015601090004
1631
ICHA FITRIA
ANAK
16/01/2009
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,764 0001601829922 1901010107630027
1635
BAHARUDIN
PESERTA
01/07/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,765 0001601836503 1901015004660002
1635
PARNI
ISTRI
10/04/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,766 0001601829944 1901014811010007
1635
AYU LESTARI
ANAK
08/11/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,767 0001601829955 1901011703800003
1638
WISNU ISWAHYUDI
PESERTA
17/03/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,768 0001601829977 1901016104760001
1638
AMINIK KARTINI
ISTRI
21/04/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 164 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,769 0001601830067 1901011706430001
1656
SUHAILI
PESERTA
17/06/1943
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,770 0001601830091 1901012003600001
1661
HADI PRAYITNO
PESERTA
20/03/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,771 0001601836694 1901015004700004
1661
PONISARI
ISTRI
10/04/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,772 0001601830113 1901014707960007
1661
YUNITA SARI
ANAK
10/06/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,773 0001601830135 1901012103680007
1666
ERWAN
PESERTA
21/03/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,774 0001601836727 1901015212680009
1666
MARIA
ISTRI
12/12/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,775 0001601830157 1901018902980003
1666
RIA AYU WAN
ANAK
29/02/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,776 0001601836738 1901014305990010
1666
MEI LINDA
ANAK
05/03/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,777 0001601830179 1901014101500002
1670
MULYANI
PESERTA
01/01/1950
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,778 0001601830181 1901012302710001
1671
IRSYADI
PESERTA
23/02/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,779 0001601836749 1901015206820001
1671
YUNI ISTIYANI
ISTRI
06/12/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,780 0001601830214 1901011611040001
1671
SULTAN SYARIP WIJAYA
ANAK
16/11/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,781 0001601836751 1901014511010001
1671
KOWIYAH RATNA SARI
ANAK
11/05/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,782 0001601830247 1901011710830005
1679
FREDI INGGAWAN
PESERTA
17/10/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,783 0001601836806 1901014212900004
1679
ANITA
ISTRI
12/02/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,784 0001601830269 1901012609070005
1679
RAFFI RAMADHAN
ANDAFRETA
ANAK
26/09/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,785 0001601836817 1901012605120003
1679
ZEVHAZ ALBIYAN ANDAFRETA ANAK
26/05/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,786 0001601830282 1901010103590002
1683
Isfaludin
PESERTA
03/01/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,787 0001601836828 1901014708590000
1683
Tinza
ISTRI
08/07/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,788 0001601836839 1901014306900001
1683
Ismi Yunita
ANAK
06/03/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,789 0001601830315 1901011806530004
1688
Tamrin Tahzar
PESERTA
18/06/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,790 0001601836841 1901014808650002
1688
Comalia Dasir
ISTRI
08/08/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,791 0001601830337 1901010612870005
1688
Erfandi
ANAK
12/06/1987
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 165 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,792 0001601830372 1901011909820003
1704
Suryono
PESERTA
19/09/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,793 0001601830383 1901015303880000
1704
SARLINDA
ISTRI
13/03/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,794 0001601830405 1901014701090002
1704
Yory Revalinda
ANAK
01/07/2009
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,795 0001601836929 1901010004070003
1704
Suyendra Aprilianto
ANAK
04/09/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,796 0001601830416 1901010808710002
1708
Ridwan
PESERTA
08/08/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,797 0001601836931 1901014801750002
1708
Suciani
ISTRI
01/08/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,798 0001601830438 1901015610980003
1708
Aka Firdaus
ANAK
16/10/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,799 0001601830449 1901016802020002
1708
Mirwan Habibi
ANAK
26/09/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,800 0001601836942 1901011607080001
1708
Rizkian Purnama
ANAK
16/07/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,801 0001601830462 1901012010990003
1713
Tito Samontri
PESERTA
19/10/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,802 0001601836953 1901015905000002
1713
Meisi Lila Fathian
TAMBAHAN
19/06/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,803 0001601830484 1901012606400002
1716
Bujang Anuar
PESERTA
26/06/1940
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,804 0001601830495 1901010307600002
1718
THAM SUN PHIN
PESERTA
07/03/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,805 0001601836964 1901016510580002
1718
TJHIN NGIE MOIJ
ISTRI
25/10/1958
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,806 0001601830517 1901016106980003
1718
YULIANA
ANAK
21/06/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,807 0001601830541 3604090710710005
1727
WARDOYO
PESERTA
10/07/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,808 0001601837032 3604096704760006
1727
LIANA LUKI SHINTA
ISTRI
27/04/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,809 0001601830574 3604096606100001
1727
EVITA DWI ARYANI
ANAK
26/06/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,810 0001601837043 3604095701990008
1727
YOSHINTA FITRA
ANAK
17/01/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
3,811 0001601830631 1901015912620004
1752
Kinah
PESERTA
19/12/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,812 0001601830697 1901011193300002
1764
Romlan
PESERTA
11/03/1930
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,813 0001601830732 1901012306480001
1770
Basirun
PESERTA
20/08/1948
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,814 0001601837324 1901017009480001
1770
Telaseh
ISTRI
05/03/1948
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 166 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,815 0001601830754 1901010607720002
1772
Sutrisman
PESERTA
06/07/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,816 0001601830765 1901013107700002
1773
Darmawan
PESERTA
31/07/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,817 0001601837335 1901015710700001
1773
Zubaidah
ISTRI
17/10/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,818 0001601830787 1901010110980005
1773
Azwan Harpansyah
ANAK
01/10/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,819 0001601830798 1901011002760003
1776
Bujang
PESERTA
21/08/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,820 0001601837346 1901014805760003
1776
Deswati
ISTRI
28/12/1976
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,821 0001601830833 1901011905630002
1782
Usman
PESERTA
19/05/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,822 0001601837381 1901015508600001
1782
Daimiri
ISTRI
15/08/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,823 0001601830888 1901012709530001
1790
Suhartono
PESERTA
27/09/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,824 0001601837447 1901014810580001
1790
Aliyah
ISTRI
16/06/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,825 0001601830901 1901015604950001
1790
Novita Sari
ANAK
16/04/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,826 0001601830989 1901012509650001
1808
Djailani
PESERTA
25/09/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,827 0001601837594 1901017112690005
1808
Eriyani
ISTRI
31/12/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,828 0001601831002 1901014206920004
1808
Voradia Vobi
ANAK
02/06/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,829 0001601831024 1901010205970001
1808
Nico Julianto
ANAK
02/06/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,830 0001601831068 1901015503740002
1817
Sri Santi
PESERTA
15/03/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,831 0001601831081 1901015106980004
1817
Trisna Anggraini
ANAK
11/06/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,832 0001601837651 1901012310050005
1817
Agung Kurniawan
ANAK
23/10/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,833 0001601831103 1901014806530003
1825
Salbiah
PESERTA
13/10/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,834 0001601837662 1901010908820001
1825
Sriyadi
ANAK
08/09/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,835 0001601831125 1901015707520002
1827
Rusdiyanto
PESERTA
28/01/1978
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,836 0001601837673 1901012211910003
1827
Fahmi
ANAK
04/11/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,837 0001601831193 1901012305550001
1837
Sumadi
PESERTA
23/05/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 167 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,838 0001601837763 1901016103610003
1837
Marida
ISTRI
21/05/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,839 0001601831215 1901012305920002
1837
Randi Felani
ANAK
23/05/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,840 0001601831226 1901012412320001
1837
Supardjan
TAMBAHAN
24/12/1937
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,841 0001601831248 1901011411650001
1845
Zulkipli
PESERTA
14/11/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,842 0001601837785 1901016010760002
1845
Inderianti
ISTRI
01/07/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,843 0001601831261 1901014310900001
1845
Gina Listiani
ANAK
03/10/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,844 0001601831283 1901010310951901
1845
Andika
ANAK
03/10/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,845 0001601837796 1901012712940003
1845
Deni Setiawan
ANAK
27/12/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,846 0001601831294 1901012404640005
1850
Wisnu Bin Badarudin
PESERTA
24/04/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,847 0001601837807 1901014107650019
1850
Nur Asiah
ISTRI
01/07/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,848 0001601831316 1901010508980005
1850
Dede Ariyanto
ANAK
05/08/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,849 0001601837818 1901012504050006
1850
Irodatun Hafiz
ANAK
20/04/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,850 0001601831338 1901012102860006
1855
Koko Setiawan
PESERTA
21/02/1986
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,851 0001601831406 1901010708660001
1871
Agus Supriyanto
PESERTA
07/08/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,852 0001601831428 1901014411750004
1871
Herlina Novira
ISTRI
02/11/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,853 0001601837954 1901011504010001
1871
Mohammad Fajar Al Vino
ANAK
15/04/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,854 0001601837965 1901014411040002
1871
Adinda Rahmadani
ANAK
04/11/2004
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,855 0001601837976 1901014707110000
1871
Tania Putri Anastasya
ANAK
07/07/2011
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,856 0001601831463 1901010912870003
1876
Dedy Darmawan
PESERTA
09/12/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,857 0001601831485 1901014711920006
1876
Nofita
ISTRI
07/11/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,858 0001601831507 1901012509090003
1876
Kenzin Putra Darmawan
ANAK
25/09/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,859 0001601831518 1901012905120004
1876
Kenzo Putra Darmawan
ANAK
25/09/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,860 0001601831586 1901015207530003
1891
Djaniarti
PESERTA
12/07/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 168 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,861 0001601831619 1901010401560003
1899
Rudy Tansil
PESERTA
04/01/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,862 0001601838145 1901015001580001
1899
Liong Sui Ngiat
ISTRI
10/01/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,863 0001601838156
1899
FERA TANSIL
ANAK
29/11/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,864 0001601831643 1901012709600002
1899
Pendy Tansil
TAMBAHAN
29/09/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,865 0001601831722 1901032405850005
1917
Fendi
PESERTA
24/05/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,866 0001601838292 1901034404860001
1917
Eka Aprilia Ariesta
ISTRI
04/04/1986
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,867 0001601838303 1901032910090003
1917
Deffan Octo Steven Gerald
ANAK
29/10/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,868 0001601831755 1901011207680002
1920
Ng sin Po
PESERTA
12/07/1968
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,869 0001601831834 1901011405530002
1933
Fendy
PESERTA
14/05/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,870 0001601831856 1901016005900004
1933
Meiyunni Tansil
ANAK
20/05/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,871 0001601838426 1901011106820003
1933
Firmanto
ANAK
15/11/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,872 0001601831878 1901012703040002
1941
Ricky Andrianto
PESERTA
27/03/2004
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,873 0001601838448 1901014109080004
1941
Cynthia Bella Ardayanti
ANAK
01/09/2008
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,874 0001601831935 1901014406630003
1952
Lo Ai Lie
PESERTA
04/06/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,875 0001601831946 1901014605940001
1953
Meiriana Taurensya
PESERTA
06/05/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,876 0001601831992 1901012602560002
1962
Kap Men
PESERTA
26/02/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,877 0001601838617 1901015007650003
1962
Hon Hian Tjhiong
ISTRI
10/07/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,878 0001601838628 1901016409060003
1962
Vei Ren
ANAK
24/09/2006
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,879 0001601832025 1901012806450001
1966
Loe Djoen Lie
PESERTA
28/06/1945
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,880 0001601832036 1901017007480001
1966
Boen Kim Foeng
ISTRI
30/07/1948
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,881 0001601832104 1901011502420002
1984
Loe Men Kwet
PESERTA
15/02/1942
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,882 0001601838764 1901016801450001
1984
Lie Aij Tjhin
ISTRI
28/01/1945
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,883 0001601832126 1901011702760004
1984
Suang Suang
ANAK
17/02/1976
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 169 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,884 0001601832137 1901010602910003
1984
Suseno
ANAK
06/02/1991
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,885 0001601832183 1901016005940002
1999
Meli Ratna Sari
PESERTA
20/05/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,886 0001601832194 1901011003970001
1999
Endi Susanto
TAMBAHAN
10/03/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,887 0001601832227 1901010508590003
2009
Baharudin
PESERTA
05/08/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,888 0001601832238 1901017112670005
2009
Nurhayati
ISTRI
13/12/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,889 0001601838887 1901011808980003
2009
Agung Pratama
ANAK
18/08/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,890 0001601838898 1901015104090001
2009
Sari Cempaka
ANAK
11/04/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,891 0001601832262 1901012911590002
2013
Sudarno
PESERTA
29/11/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,892 0001601832273 1901015604630003
2013
Nur asni
ISTRI
16/04/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,893 0001601832284 1901010604960004
2013
Apriyansyah
ANAK
06/04/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,894 0001601832295 1901016104750004
2016
Emmi Martina
PESERTA
16/04/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,895 0001601832306 1901011911010004
2016
Ogi Setiawan
ANAK
19/11/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,896 0001601832317 1901011310050008
2016
Fadil Pramana
ANAK
13/10/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,897 0001601832328 1901014107130001
2016
Nursyifa Ummi Azzarah
ANAK
01/07/2013
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,898 0001601832339 1901014107400001
2020
Maili
PESERTA
01/07/1940
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,899 0001601832341 1901010704670011
2020
Daroni
ANAK
22/03/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,900 0001601832352 1901011002690005
2020
Darwis
ANAK
30/01/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,901 0001601832363 1901012512570001
2023
Zainal
PESERTA
25/12/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,902 0001601832374 1901014112590002
2023
Rosmina
ISTRI
01/12/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,903 0001601832385 1901011206900002
2023
Syahrudin
ANAK
12/06/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,904 0001601832396 1901015208470001
2026
Haria
PESERTA
12/08/1947
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,905 0001601832407 1901012612740002
2026
Syarifudin
ANAK
26/12/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,906 0001601832418 1901010303580005
2028
Nur Hamdani HS
PESERTA
03/03/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 170 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,907 0001601832429 1901014107640004
2028
Erwaina
ISTRI
01/06/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,908 0001601832431 1901014101600008
2030
Almi
PESERTA
01/01/1948
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,909 0001601832442 1901015010620006
2030
Heri Kurniawan
ANAK
11/09/1984
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,910 0001601832453 1901016105950002
2030
Mayliza Kurnia
ANAK
21/05/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,911 0001601832464 1901011301870002
2033
Iki Riadi
PESERTA
13/01/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,912 0001601832475 1901015411920001
2033
Maimunah
ISTRI
14/11/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,913 0001601832486 1901013009120003
2033
Raditiya
ANAK
30/09/2012
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,914 0001601832497 1901010404510002
2036
Robert Suratno Umar
PESERTA
04/04/1951
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,915 0001601832508 1901014207550005
2036
Juma'ah
ISTRI
12/07/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,916 0001601832519 1901013012570004
2038
Ismail
PESERTA
30/12/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,917 0001601832521 1901014808600001
2038
Alba
ISTRI
08/08/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,918 0001601832532 1901012708470001
2040
Muhammad Nurhasan
PESERTA
27/08/1947
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,919 0001601832543 1901014510490001
2040
Rusmini
ISTRI
05/10/1949
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,920 0001601832554 1901017105540003
2042
Saidati
PESERTA
14/07/1952
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,921 0001601832565 1901011802740003
2042
Supianto
ANAK
18/02/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,922 0001601832576
2044
SOLIHIN
PESERTA
26/12/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,923 0001601832587 1901014803090001
2044
Aulia Nikesha
ANAK
08/03/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,924 0001601832598 1901014609480001
2048
Rohima
PESERTA
06/09/1948
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,925 0001601832609 1901012101740002
2049
Wesi Sahriyan
PESERTA
21/01/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,926 0001601832611 1901015011770001
2049
Nurpah
ISTRI
10/11/1977
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,927 0001601832622 1901011101020001
2049
Wisnu Adi Gunawan
ANAK
11/01/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,928 0001601832633 1901016308060009
2049
Winda Nurvita
ANAK
23/08/2006
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,929 0001601832644 1901016612110002
2049
Desi Nur Anggraeni
ANAK
26/12/2011
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 171 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,930 0001601832655 1901015410600003
2054
Anna
PESERTA
14/10/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,931 0001601832666 1901012707690004
2055
Nazarudin
PESERTA
27/07/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,932 0001601832677 1901014808970002
2055
Ayu Tantia
ANAK
28/08/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,933 0001601832688 1901014908010001
2055
Nadia
ANAK
29/11/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,934 0001601832699 1901011508600001
2059
Sahari Z
PESERTA
15/08/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,935 0001601832701 1901016003590001
2059
Ruminah
ISTRI
22/08/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,936 0001601832712 1901014605820007
2059
Melani
ANAK
06/05/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,937 0001601832723 1901016809440001
2062
Kasimawati
PESERTA
28/09/1944
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,938 0001601832734 1901012510510002
2063
Rusdi Kuat
PESERTA
25/10/1951
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,939 0001601832745 1901015701540001
2063
Asmara Murni
ISTRI
17/01/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,940 0001601832756 1901012605750002
2063
Slamet Budiono
ANAK
26/05/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,941 0001601832767 1901012410760005
2063
Risyanto
ANAK
24/10/1976
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,942 0001601832778 1901011001670002
2067
Edy Suherman
PESERTA
10/01/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,943 0001601832789 1901015112700003
2067
Ellya
ISTRI
11/12/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,944 0001601832791 1901016212930004
2067
Sartika Damayanti
ANAK
22/12/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,945 0001601832802 1901012910000005
2067
Muhammad Rizki
ANAK
29/10/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,946 0001601832813 1901015311050006
2067
Adelia Syawitri
ANAK
13/11/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,947 0001601832824 1901012911630001
2072
Suherli
PESERTA
29/11/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,948 0001601832835 1901014808700006
2072
Misna
ISTRI
08/08/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,949 0001601832846 1901012501930001
2072
Heru Anggara
ANAK
25/01/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,950 0001601832857 1901010904970001
2072
Hadi Afrian
ANAK
09/04/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,951 0001601832868 1901011812090001
2072
Hajid Arie Muharrom
ANAK
18/12/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,952 0001601832879 1901012212660001
2080
Arifin
PESERTA
22/12/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 172 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,953 0001601832881 1901014411690001
2080
Karmawati
ISTRI
04/11/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,954 0001601832892 1901015308940005
2080
Fifi Arianti
ANAK
13/08/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,955 0001601832903 1901011111600002
2083
M. Satar
PESERTA
11/11/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,956 0001601832914 1901014202720002
2083
Aslamiah
ISTRI
02/02/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,957 0001601832925 1901010109970004
2083
Andhika Felayati
ANAK
01/09/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,958 0001601832936 1901016904030003
2083
Rania Firanti
ANAK
29/04/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,959 0001601832947 1901010811660001
2087
Suwandi
PESERTA
08/11/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,960 0001601832958 1901015802690009
2087
Aminah
ISTRI
18/02/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,961 0001601832969 1901016208950002
2087
Shela Agustia
ANAK
22/08/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,962 0001601832971 1901015506000003
2087
Shindy Merlian
ANAK
15/06/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,963 0001601832982 1901013007800002
2091
Achyar Sani
PESERTA
30/07/1980
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,964 0001601832993 1901015212820005
2091
Sumiati
ISTRI
12/12/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,965 0001601833004 1901016410020002
2091
Alya Syafitri
ANAK
24/10/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,966 0001601833015 1901011704040005
2091
Melqi Apriandy
ANAK
17/04/2004
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,967 0001601833026 1901010706130001
2091
Iqbal Kurniawan
ANAK
07/06/2013
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,968 0001601833037 1901010702680002
2096
A Latief
PESERTA
07/02/1968
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,969 0001601833048 1901015709710002
2096
Indrawasih
ISTRI
17/09/1971
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,970 0001601833059 1901012403980001
2096
Muhammad Arpandi
ANAK
24/03/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,971 0001601833061 1901012509720008
2099
Yuspendi Yusuf
PESERTA
25/09/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,972 0001601833072 1901016004820007
2099
Yuna
ISTRI
20/04/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,973 0001601833083 1901015112000002
2099
Desi Aryanti
ANAK
15/12/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,974 0001601833094 1901010311030004
2099
Novri Aryansyah
ANAK
03/11/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,975 0001601833105 1901010609790003
2103
Syawaludin
PESERTA
06/09/1979
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 173 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,976 0001601833116 1901015802850009
2103
Natalia
ISTRI
18/02/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,977 0001601833127 1901015811070003
2103
Vira Darlianti
ANAK
18/11/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,978 0001601833138 1901015008030002
2103
Dela Gusdianti
ANAK
05/08/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,979 0001601833149 1901014806570003
2107
Kasiati
PESERTA
08/06/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,980 0001601833151 1901010203900006
2107
Sutrok
ANAK
02/03/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,981 0001601833162 1901011010780001
2109
Edwin Ramon
PESERTA
10/10/1978
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,982 0001601833173 1901014505770006
2109
Sri Lestari
ISTRI
05/05/1977
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,983 0001601833184 1901012603960001
2109
Ryan Saputra
ANAK
23/06/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,984 0001601833195 1901015501020004
2109
Intan Kharisma Putri
ANAK
05/01/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,985 0001601833206 1901011303800006
2113
Arpan
PESERTA
13/03/1980
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,986 0001601833217 1901015904830003
2113
Desi Arvina
ISTRI
19/04/1983
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,987 0001601833228 1901016410090002
2113
Arkeyza Oktariani
ANAK
24/10/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,988 0001601833239 1901010601130003
2113
Mifzal Zaki Fahturahman
ANAK
06/01/2013
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,989 0001601833241 1901012706800003
2117
Joni Aprizal
PESERTA
27/06/1980
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,990 0001601833252 1901012009050002
2117
Jumadi Al-Rohmad
ANAK
20/09/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,991 0001601833263 1901016906140002
2117
Artanti Lucy Artini
ANAK
29/06/2014
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,992 0001601833274 1901010607199991
2120
Cumin
PESERTA
06/07/1919
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,993 0001601833285 1901013006690004
2121
Zuhamra
PESERTA
30/06/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,994 0001601833296 1901012508690004
2123
Budiman
PESERTA
25/08/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,995 0001601833307 1901014702760004
2123
Ita Forpiana
ISTRI
17/02/1976
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,996 0001601833318 1901016411550002
2125
Liong Pit Soei
PESERTA
24/11/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,997 0001601833329 1901012703750005
2126
Sin Li
PESERTA
27/03/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
3,998 0001601833331 1901017108810008
2126
Gusmaniar
ISTRI
31/08/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 174 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
3,999 0001601833342 1901011511050002
2126
Alfin
ANAK
15/11/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,000 0001601833353 1901012503060005
2126
David
ANAK
25/03/2006
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,001 0001601833364 1901015803570001
2130
Noni
PESERTA
18/03/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,002 0001601833375 1901014606000001
2130
Riski Ananda Putri
ANAK
08/08/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,003 0001601833386 1901010401740004
2132
Bambang Jatmiko
PESERTA
04/01/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,004 0001601833397 1901016811740005
2132
Komsiyah
ISTRI
28/11/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,005 0001601833408 1901055906820001
2134
Ani
PESERTA
19/06/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,006 0001601833419 1901011606090004
2134
Junior Alfredo
ANAK
16/06/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,007 0001601833421 1901010404670004
2136
Tjhin Tjo Fo
PESERTA
04/04/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,008 0001601833432 1901016005730009
2136
Bong Ngiat Djin
ISTRI
16/05/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,009 0001601833443 1901010608950007
2136
Yohannes Agustin
ANAK
06/08/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,010 0001601833454 1901011401200010
2136
Andreas Juntori
ANAK
14/04/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,011 0001601833465 1901015404290002
2136
Tjhin Sui Kheng
TAMBAHAN
14/04/1929
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,012 0001601833476 1901014608860005
2141
Fina
PESERTA
06/08/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,013 0001601833487 1901016604080003
2141
Efrilia
ANAK
25/04/2008
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,014 0001601833498 1901015805100001
2141
Meylisa Putri
ANAK
18/05/2010
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,015 0001601833509 1901011201790003
2144
Sui Cen
PESERTA
12/01/1979
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,016 0001601833511 1901015909770005
2144
Priyati
ISTRI
19/09/1977
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,017 0001601833522 1901012405000001
2144
Denny Sandra
ANAK
24/05/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,018 0001601833533 1901013101680003
2147
Rudi Margono
PESERTA
31/01/1968
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,019 0001601833544 1901014802690006
2147
Nurjani
ISTRI
08/02/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,020 0001601833555 1901014402010001
2147
Anastasyia Yefta Rudini
ANAK
04/02/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,021 0001601833566 1901011508090003
2147
Jeremi Yefta Rudini
ANAK
15/08/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 175 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,022 0001601833577 1901014401340002
2151
Lok Lian Mie
PESERTA
04/01/1934
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,023 0001601833588 1901012101580002
2152
Tjhin Tjo Min
PESERTA
21/01/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,024 0001601833599 1901014508570002
2152
Tjoe Jin Fa
ISTRI
05/08/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,025 0001601833601 1901014604900001
2152
Yulnita
ANAK
06/04/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,026 0001601833612 1901014909980003
2152
Yulfita
ANAK
09/09/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,027 0001601833623 1901010605610006
2156
Liem Khin Fong
PESERTA
06/05/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,028 0001601833634 1901016204620002
2156
Ten Ngit Siam
ISTRI
22/04/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,029 0001601833645 1901012508490002
2158
Boen Nam San
PESERTA
25/08/1949
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,030 0001601833656 1901010505730007
2159
Khin Hioen
PESERTA
05/05/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,031 0001601833667 1901016505910001
2159
Mellysia
ISTRI
25/05/1991
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,032 0001601833678 1901015106090002
2159
Klaudia Tabita
ANAK
11/06/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,033 0001601833689 1901012112120001
2159
Gilbert Giovani
ANAK
12/12/2012
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,034 0001601833691 1901010906140003
2159
Gabriel Stevanus
ANAK
09/06/2014
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,035 0001601833702 1901011203650003
2164
Mahmud
PESERTA
12/03/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,036 0001601833713 1901015104620003
2164
Ho Sun Siat
ISTRI
11/04/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,037 0001601833724 1901011411076615
2164
Darwin
ANAK
08/12/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,038 0001601833735 1901012612550001
2167
Tjhin Djim Hian
PESERTA
26/12/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,039 0001601833746 1901016806560001
2167
Se Thoe Kim
ISTRI
28/06/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,040 0001601833757 1901012008810001
2167
Sui Kong
ANAK
17/11/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,041 0001601833768 1901011711850002
2167
Erwin
ANAK
20/08/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,042 0001601833779 1901011306560001
2171
Liew Djoen Sak
PESERTA
13/06/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,043 0001601833781 1901012409580003
2172
Surian Djunaidi
PESERTA
24/09/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,044 0001601833792 1901016705650001
2172
Lay Sui Nyun
ISTRI
27/05/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 176 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,045 0001601833803 1901012609920004
2172
Rony Sanjaya
ANAK
26/09/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,046 0001601833814 1901014808950005
2172
Renny Christina
ANAK
08/08/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,047 0001601833825 1901010804560001
2176
Bong Djoeng Tjhauw
PESERTA
08/04/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,048 0001601833836 1901014505570001
2176
Ho Tjin Mew
ISTRI
05/05/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,049 0001601833847 1901012309800001
2176
Tet Kwang
ANAK
23/09/1980
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,050 0001601833858 1901015312830004
2176
Desi Yanti
ANAK
13/12/1983
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,051 0001601833869 1901011005880010
2176
Hendra
ANAK
10/05/1988
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,052 0001601833871 1901010311850005
2181
Hendri
PESERTA
03/11/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,053 0001601833882 1901016602810002
2181
Nurhayati
ISTRI
26/02/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,054 0001601833893 1901015109060005
2181
Selly Cheristiana
ANAK
11/09/2006
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,055 0001601833904 1901017108110001
2181
Ester Fitriana
ANAK
31/08/2011
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,056 0001601833915 1901015110550001
2185
Liauw Khiuk Fa
PESERTA
11/10/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,057 0001601833926 1901017012520007
2188
Hie Soet Djie
PESERTA
30/12/1952
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,058 0001601833937 1901010508680002
2189
Herry
PESERTA
05/08/1968
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,059 0001601833948 1901015302750001
2189
Yumi
ISTRI
13/02/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,060 0001601833959 1901017010980001
2189
Sheren Vanessa
ANAK
30/10/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,061 0001601833961 1901015910030003
2189
Jennifer Patricia
ANAK
19/10/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,062 0001601833972 1901013107070001
2189
Rico Norman Lim
ANAK
31/07/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,063 0001601833983 1901010604710001
2194
Sujandi
PESERTA
08/04/1971
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,064 0001601833994 1901016506740006
2194
Ngiat Tju
ISTRI
25/06/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,065 0001601834005 1901016008950001
2194
Reny Gustia
ANAK
20/08/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,066 0001601834016 1901015511990004
2194
Novelia
ANAK
15/11/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,067 0001601834027 1901014502800006
2198
Susi
PESERTA
05/02/1980
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 177 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,068 0001601834038 1901010606080002
2198
Stanley Wilson
ANAK
06/06/2008
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,069 0001601834049 1901016310100002
2198
Dina Frantika
ANAK
23/10/2010
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,070 0001601834051 1901010806120003
2198
Bryan Ivander
ANAK
08/06/2012
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,071 0001601834062 1901014402580005
2202
Karsia Djapri
PESERTA
04/02/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,072 0001601834073 1901014403940001
2202
Marlina
ANAK
04/03/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,073 0001601834084 1901016105470001
2204
Lioe A Njun
PESERTA
21/05/1947
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,074 0001601834095 1901012909720003
2204
Sak Tjoeng
ANAK
29/09/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,075 0001601834106 1901011905750001
2204
Sak Pin
ANAK
19/05/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,076 0001601834117 1901010912540001
2207
Sin Hok
PESERTA
09/12/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,077 0001601834128 1901016912610001
2207
Kartini
ISTRI
29/12/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,078 0001601834139 1901012712930001
2207
Chandra Vinata
ANAK
27/12/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,079 0001601834141 1901010312000004
2212
Steven Launando
PESERTA
03/12/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,080 0001601834163 3174051909700006
1169
SAIDI
PESERTA
19/09/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,081 0001601834174 3174054703810003
1169
ERNAWATI
ISTRI
07/03/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,082 0001601834185 3174055101030002
1169
SYARO ALA DESTERI
ANAK
11/12/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,083 0001601834196 3174055112970005
1169
ZUKHRU FINAWATI
ANAK
01/01/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,084 0001601834207 1901010402790002
1173
SUPARJAN
PESERTA
04/02/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,085 0001601834218 1901015009780004
1173
ASIAH
ISTRI
10/09/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,086 0001601834229 1901011501040002
1173
AINUL ROPI'I
ANAK
15/01/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,087 0001601834231 1901019060800002
1173
AUREL RIDHO HASANAH
ANAK
19/06/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,088 0001601834253 1901012301650001
1181
MISNAWI
PESERTA
23/01/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,089 0001601834264 1901014101750008
1181
ROJA'A
ISTRI
01/01/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,090 0001601834275 1901011101930004
1181
SONA ANDIKA
ANAK
11/01/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 178 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,091 0001601834286 1901015408970002
1181
MELDA AGUSTIN
ANAK
14/08/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,092 0001601834297 1901012207890005
1185
RIAN PRAMANA
PESERTA
22/07/1989
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,093 0001601834308 1901014101890002
1185
A. RITA
ISTRI
01/01/1989
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,094 0001601834319 1901011306080001
1185
REHAN
ANAK
13/06/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,095 0001601834321 1901010105120001
1185
FAZLI
ANAK
01/05/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,096 0001601834332 1901014208630001
1189
ROKIAH
PESERTA
02/08/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,097 0001601834343 1901011708540001
1189
NASIR
TAMBAHAN
17/08/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,098 0001601834354 1901010802480002
1193
MARKUM
PESERTA
08/02/1948
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,099 0001601834365 1901014306540001
1193
SOPIAH
ISTRI
03/08/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,100 0001601834376 1901015210830002
1193
YENI OCTARINA
ANAK
12/10/1983
BP ANORA
01/01/2015
AKTIF
19,225
30/12/2014
4,101 0001601834387 1901011904910001
1193
SYAHRIAL FITRAH
ANAK
19/04/1991
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,102 0001601834398 1901016901950001
1193
RANTI EKASARI
ANAK
29/01/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,103 0001601834455 1901010704770007
1215
MIDUADI
PESERTA
07/04/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,104 0001601834466 1901016502790001
1215
ELFI SUSANTI
ISTRI
25/02/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,105 0001601834477 1901012010000003
1215
DAVID FRANSISCO
ANAK
20/10/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,106 0001601834488 1901015409020010
1215
SERVINA DWI FRANSISKA
ANAK
14/09/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,107 0001601834499 1901012110070002
1215
FIRLIAN FERIS
ANAK
21/10/2007
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,108 0001601834501 1901016412920003
1222
DESTI ARISTA
PESERTA
24/12/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,109 0001601834567 1507020710500002
1238
PANJI
PESERTA
07/10/1950
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,110 0001601834578 1507025108570002
1238
SITI AMINAH
ISTRI
11/08/1957
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,111 0001601834589 1901016801970003
1246
NURUL RAHMADANIA
PESERTA
28/01/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,112 0001601834635 1901050203860004
1261
YUDIANTO
PESERTA
02/03/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,113 0001601834646 1901014908920003
1261
RIA GUSTIA
ISTRI
09/08/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 179 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,114 0001601834657 1901010708120004
1261
ANDESTHA PUTRA
RAMADHAN
ANAK
07/08/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,115 0001601834668 1901011005710004
1267
ACHMAD FIRDAUS
PESERTA
10/05/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,116 0001601834679 1901014912740001
1267
SUSIANA
ISTRI
09/12/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,117 0001601834681 1901014110040006
1267
JAMILAH
ANAK
01/10/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,118 0001601834692 1901012012110001
1267
IQBAL
ANAK
20/12/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,119 0001601834703 1901011808840008
1272
SYAMSUDIN
PESERTA
18/08/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,120 0001601834714 1904034101910007
1272
IIN SUMARNI
ISTRI
01/01/1991
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,121 0001601834725 1901012706110002
1272
REHAN JUNIANSYAH
ANAK
27/06/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,122 0001601834736 1901011003580002
1275
SARINO
PESERTA
10/03/1958
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,123 0001601834747 1901015203620001
1275
SUTINA
ISTRI
12/03/1962
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,124 0001601834758 1901011808840007
1275
SYAMSUDIN
ANAK
16/08/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,125 0001601834769 1901016611190004
1275
LISNA ANDIKA
ANAK
26/11/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,126 0001601834793 1902012310780003
1284
ZULKARNAIN
PESERTA
23/10/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,127 0001601834804 1902015702790001
1284
WAODE SITI ZUBAIDAH
ISTRI
17/02/1979
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,128 0001601834815 1902011607100001
1284
FADILLA PUTRA
ANAK
16/07/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,129 0001601834861 1901012104590004
1300
SADDULA
PESERTA
21/04/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,130 0001601834872 1901015903560004
1300
SURYATI
ISTRI
19/03/1956
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,131 0001601834883 1901016312890005
1303
MERI HERDIANTI
PESERTA
23/12/1989
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,132 0001601834916 1901011303780002
1312
SUHERMAN
PESERTA
13/03/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,133 0001601834927 1901016970820008
1312
LINA
ISTRI
29/10/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,134 0001601834938 1901012910040001
1312
ANDI
ANAK
29/10/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,135 0001601834949 1901012504100002
1312
ANDRE
ANAK
25/04/2010
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,136 0001601835006 1901011508840005
1332
ABDUL AZIZ
PESERTA
15/08/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 180 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,137 0001601835017 1901014107860017
1332
RUMSIYAH
ISTRI
01/07/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,138 0001601835028 1901010404090004
1332
SHOFIYULLOH AZIZ
ANAK
04/04/2009
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,139 0001601835164 1901012102880003
1360
NUROHIM
PESERTA
21/02/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,140 0001601835175 1901014203920002
1360
MISNAWATI
ISTRI
02/03/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,141 0001601835186 1901015804140001
1360
AULIA IZZATUNNISA
ANAK
18/04/2014
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,142 0001601835221 1901010504600002
1373
THAMRIN
PESERTA
05/04/1960
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,143 0001601835232 1901015206650002
1373
JUMARNI
ISTRI
12/06/1985
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,144 0001601835254 1901012411950002
1373
MULYONO
ANAK
24/11/1995
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,145 0001601835265 1901011711970002
1373
PURWATI
ANAK
07/11/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,146 0001601835276 1805021212690008
1379
JASMONO
PESERTA
12/12/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,147 0001601835287 1805024506750006
1379
SUMIYATI
ISTRI
05/06/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,148 0001601835298 1805025212910009
1379
TASRIAH
ANAK
12/12/1991
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,149 0001601835309 1805026012930002
1379
MUNDIYATI
ANAK
20/12/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,150 0001601835355 1901011505750005
1391
HASNAN HABIB
PESERTA
15/05/1975
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,151 0001601835366 1901014808770006
1391
GUSTANI
ISTRI
08/08/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,152 0001601835377 1901014512970005
1391
FARA DINDA CICILIA
ANAK
05/12/1997
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,153 0001601835388 1901015605030003
1391
FEBY ANANDA REGITA
ANAK
16/05/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,154 0001601835399 1901015701130002
1391
NAURA SYAQILA AZAHRA
ANAK
17/01/2013
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,155 0001601835445 1901016008480002
1410
TJHIN DJAT MIE
PESERTA
20/08/1948
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,156 0001601835467 1901011906510002
1418
LOE JOEK TET
PESERTA
19/06/1951
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,157 0001601835478 1901016711540004
1418
BOEN KIM LOEN
ISTRI
27/11/1954
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,158 0001601835491 1901012305710001
1424
SUHARDI
PESERTA
23/05/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,159 0001601835502 1901014708990006
1424
EKA AGUSTINE
ANAK
07/08/1999
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 181 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,160 0001601835513 1901012906080001
1424
ZAGI SUGIANDI
ANAK
29/06/2006
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,161 0001601835524 1901011002880002
1424
PERIANSYAH
TAMBAHAN
10/02/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,162 0001601835535 1901012307800002
1432
SIHOLAZI SK.PAHWIN
PESERTA
23/07/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,163 0001601835546 1901016811820002
1432
JAURAH
ISTRI
28/11/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,164 0001601835557 1901016307010004
1432
FATRIASIA R.W.
ANAK
23/07/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,165 0001601835568 1901011812030001
1432
M.FAJAR SIDIK
ANAK
18/12/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,166 0001601835579 1901013007080001
1432
AHMAD FAHRI
ANAK
30/07/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,167 0001601835581 1901011212593003
1437
TJEN TJIT HAK
PESERTA
12/12/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,168 0001601835592 1901015201023001
1437
BOEN EN NIO
ISTRI
12/01/1962
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,169 0001601835603 1901010108638005
1437
SEPTU MISRIO
ANAK
01/09/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,170 0001601835614 1901015410880002
1437
JANUARI FANGYU
ANAK
14/01/1989
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,171 0001601835625 1901014505940006
1437
MEIRIKA
ANAK
05/05/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,172 0001601835647 1901011310810002
1445
HENDRI
PESERTA
13/10/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,173 0001601835658 1901015306830007
1445
YUNITA
ISTRI
13/06/1983
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,174 0001601835669 1901016109050006
1445
LITTA SEPTIANI
ANAK
21/09/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,175 0001601835671 1901015605130001
1445
FHELICYAH ALZAHRA
ANAK
16/05/2013
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,176 0001601835783 1901010910700003
1474
SAMAD
PESERTA
09/10/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,177 0001601835794 1901016110700001
1474
BUNLAH
ISTRI
21/10/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,178 0001601835805 1901015708940002
1474
ARIYENI
ANAK
17/08/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,179 0001601835906 1901012006780006
1504
BUDIMAN
PESERTA
20/06/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,180 0001601835917 1901015004780006
1504
RONA
ISTRI
10/04/1978
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,181 0001601835928 1901014310050003
1504
MUTIARA RAHMA DONA
ANAK
03/10/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,182 0001601835939 1901017105120001
1504
PUTRI SHAKINA
ANAK
31/05/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 182 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,183 0001601835952 1901010309820003
1512
SAMSIDAR
PESERTA
03/09/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,184 0001601835963 1901015910900005
1512
OKTARINI
ISTRI
19/10/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,185 0001601835974 1901011506090001
1512
MUHAMMAD IKBAL
ANAK
15/06/2009
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,186 0001601836042 1901011701590004
1542
UPUK
PESERTA
17/01/1959
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,187 0001601836053 1901015504710002
1542
SERI WIDNARSIH
ISTRI
15/04/1971
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,188 0001601836064 1901011606930002
1542
ASEP KUSNANDAR
ANAK
15/06/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,189 0001601836075 1901012105960005
1542
FREDY IXANDAR
ANAK
21/05/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,190 0001601836086 1901017108980006
1542
META HANDAYANI
ANAK
31/08/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,191 0001601836097 1901016108010005
1542
DEWI NUR ARIFA
ANAK
21/08/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,192 0001601836108 1901060911630001
1548
YULHADI
PESERTA
09/11/1963
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,193 0001601836119 1901065912700001
1548
ASLIANA
ISTRI
19/12/1970
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,194 0001601836121 1901060405870001
1548
MAULANA YANDARI
ANAK
04/05/1987
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,195 0001601836132 1901061109000001
1548
MAULANA ADITYA
ANAK
11/09/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,196 0001601836143 1901062412040001
1548
AHMAD FAUZAN
ANAK
24/12/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,197 0001601836209 1901016004560003
1566
ROSMINI
PESERTA
20/04/1956
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,198 0001601836211 1901010506940004
1566
ERYADI
ANAK
05/06/1994
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,199 0001601836312 1901014402530001
1595
ZUBAIDAH
PESERTA
04/02/1953
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,200 0001601836323 1901016610110002
1598
VIVI OKTAVIA
PESERTA
26/10/2011
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,201 0001601836356 1901011210760009
1606
MISNAN
PESERTA
12/10/1976
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,202 0001601836367 1901014811620002
1606
NOVI APRIYANTI
ISTRI
08/11/1962
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,203 0001601836378 1901010306080001
1606
YUNI MAULANA
ANAK
03/06/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,204 0001601836413 1901012809580002
1617
M.YANI SATAR
PESERTA
28/09/1958
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,205 0001601836424 1901014502730007
1617
NUR'AINI
ISTRI
05/02/1973
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 183 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,206 0001601836435 1901011109960001
1617
MIRDANI
ANAK
11/09/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,207 0001601836446 1901015001980005
1617
NURHENI
ANAK
10/01/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,208 0001601836514 1901011508560002
1641
SURAJI
PESERTA
15/08/1956
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,209 0001601836525 1901015511650001
1641
SUGINEM
ISTRI
15/11/1965
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,210 0001601836536 1901014102040001
1641
SOFA QOLBI NABILA
ANAK
01/02/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,211 0001601836547 1901010303840002
1645
ZAINUDDIN
PESERTA
03/03/1984
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,212 0001601836558 1901045408860008
1645
GUSTINA
ISTRI
14/06/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,213 0001601836569 1901014706090003
1645
KHALIYA FITRI AISYAH
ANAK
07/06/2009
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,214 0001601836571 1901011110740006
1648
HENDRI S.
PESERTA
11/10/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,215 0001601836582 1901017112820007
1648
LIYANA
ISTRI
31/12/1982
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,216 0001601836593 1901016804000003
1648
SAFITRI
ANAK
28/04/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,217 0001601836604 1901012003050003
1648
LIOWALDI
ANAK
20/03/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,218 0001601836615 1901015204120001
1648
AISAH
ANAK
12/04/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,219 0001601836626 1901010605740003
1653
MAHMUD
PESERTA
06/05/1974
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,220 0001601836637 3209174711800007
1653
MARYAM
ISTRI
07/11/1980
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,221 0001601836648 1901012903130001
1653
AHMAD FIHRIAL FARIZI
ANAK
29/03/2013
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,222 0001601836659 1901011608640003
1657
ADAM
PESERTA
16/08/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,223 0001601836661 1901014609720002
1657
KAMARIAH
ISTRI
06/09/1972
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,224 0001601836672 1901014101980004
1657
MELATI SAPPITRI
ANAK
01/01/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,225 0001601836683 1901010707020004
1657
BAGAS
ANAK
07/07/2002
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,226 0001601836705 1901013009230002
1664
LIE TJHIONG DJONG
PESERTA
30/09/1923
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,227 0001601836716 1901016404230002
1664
TJONG KWAN FA
ISTRI
24/04/1923
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,228 0001601836762 1901011805770008
1675
WAHYU ACMAD TARKAM

ARIESMAN
PESERTA
18/05/1977
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 184 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,229 0001601836773 1901012302810004
1675
DODI
TAMBAHAN
23/02/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,230 0001601836784 1901015505810000
1675
CARSIH
TAMBAHAN
15/05/1981
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,231 0001601836795 1901012504040001
1675
AFANDI
TAMBAHAN
25/04/2004
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,232 0001601836852 1901016905640002
1691
Sriwati
PESERTA
29/05/1964
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,233 0001601836863 1901012103900002
1691
Andi Djawisyar
ANAK
21/03/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,234 0001601836874 1901012107880005
1693
Reviandy
PESERTA
21/07/1988
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,235 0001601836885 1901014805930004
1693
Nurita
ISTRI
05/08/1993
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,236 0001601836896 1901016710120003
1693
Nezlin Revita Khalifah
ANAK
27/10/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,237 0001601836907 1901015107960003
1702
Indri Yuliansih
PESERTA
07/11/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,238 0001601836918 1901011402010003
1702
Indra Febriansyah
ANAK
14/02/2001
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,239 0001601836975 1901011205660002
1721
S.WAHYUDI
PESERTA
05/12/1968
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,240 0001601836986 1901016201860004
1721
NURHAYATI
ISTRI
22/01/1986
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,241 0001601836997 1901010207030003
1721
JEFRY UKARIANTO
ANAK
07/02/2003
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,242 0001601837008 1901010310060005
1721
RAMDHAN UKARIANTO
ANAK
10/03/2008
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,243 0001601837019 1901012203090001
1721
REZHAN SUBHAKTI
UKARIANTO
ANAK
22/03/2009
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,244 0001601837021 1901011701120001
1721
BERY MUSTHOFA UKARIANTO ANAK
17/01/2012
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,245 0001601837054 1901012202690002
1731
ERFANSYAH
PESERTA
22/02/1969
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,246 0001601837065 1901015411660006
1731
DARIAH
ISTRI
14/11/1966
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,247 0001601837076 1901016710900002
1731
WANTI MARYANA
ANAK
27/10/1990
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,248 0001601837087 1901015011980002
1731
EVI TAMALA
ANAK
11/10/1996
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,249 0001601837098 1901017008080002
1731
LENA ASTUTI
ANAK
30/08/1998
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,250 0001601837109 1901010104000004
1731
ERSANDIANSYAH
ANAK
04/01/2000
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
4,251 0001601837111 1901012605050002
1731
RAFI FIRMANSYAH
ANAK
26/05/2005
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 185 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,252 0001601837122 1901012208760005
1745
Hendra Agus Prianto
PESERTA
22/08/1976
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,253 0001601837133 1901014308780001
1745
Maila
ISTRI
05/08/1978
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,254 0001601837144 1901016008970006
1745
Giandi Elbin Prim Landika
ANAK
20/08/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,255 0001601837155 1901010111000001
1745
Shonia Eem Yelisia
ANAK
01/11/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,256 0001601837166 1901012211060003
1745
Muhammad Rafli
TAMBAHAN
22/11/2008
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,257 0001601837177 1901012211060002
1745
Muhammad Raffi
TAMBAHAN
22/11/2008
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,258 0001601837188 1901015808090002
1745
Sherin Agus Viora
TAMBAHAN
18/08/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,259 0001601837199 1901012408480006
1754
Mustafa
PESERTA
24/08/1948
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,260 0001601837201 1901014311490004
1754
Norma
ISTRI
03/11/1949
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,261 0001601837212 1901011006730004
1754
Edy Suprianto
ANAK
10/06/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,262 0001601837223 1901016502610002
1757
Maya Mahin Hin
PESERTA
25/02/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,263 0001601837234 1901011203830001
1757
Pendi
ANAK
12/03/1983
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,264 0001601837245 1901014107511901
1759
Supana
PESERTA
01/07/1951
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,265 0001601837256 1901016006550001
1760
Asnah
PESERTA
20/06/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,266 0001601837267 1901011910880002
1760
M.Hatta
ANAK
19/10/1988
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,267 0001601837278 1901011512500003
1762
Hauli
PESERTA
15/12/1950
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,268 0001601837289 1901013112420005
1766
Cik Utih
PESERTA
31/12/1942
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,269 0001601837291 1901015311890008
1766
Cik Tun
ANAK
15/11/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,270 0001601837302 1901012502730002
1768
M. Sahir
PESERTA
25/02/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,271 0001601837313 1901015103380001
1769
Sanik
PESERTA
11/03/1938
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,272 0001601837357 1901011204730001
1778
Suhendro
PESERTA
12/04/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,273 0001601837368 1901014107730005
1778
Siti Rohyati
ISTRI
01/07/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,274 0001601837379 1901010611960002
1778
Abdi Setiawan
ANAK
06/11/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 186 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,275 0001601837392 1901011002710001
1784
Muktadin
PESERTA
07/01/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,276 0001601837403 1901014101740003
1784
Holijah
ISTRI
01/01/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,277 0001601837414 1901010505050003
1784
Ariatman
ANAK
05/05/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,278 0001601837425 1901010802120002
1784
Azril Prayuda
ANAK
05/02/2012
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,279 0001601837436 1901014304630003
1789
Sinarsih
PESERTA
03/04/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,280 0001601837458 1901010205620001
1793
Imron
PESERTA
02/05/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,281 0001601837469 1901014608640001
1793
Jumilah
ISTRI
06/08/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,282 0001601837471 1901016702940001
1793
Mentari
ANAK
27/02/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,283 0001601837482 1901010505710003
1797
Tamzil
PESERTA
05/05/1971
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,284 0001601837493 1901015901790002
1797
Tuti Jariani
ISTRI
19/01/1979
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,285 0001601837504 1901015410000002
1797
Purnama Oktavia Farani
ANAK
14/10/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,286 0001601837515 1901011705040009
1797
Ghanang Rofikal Pramuja
ANAK
17/05/2004
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,287 0001601837526 1901010206100001
1797
Barkah Khazami
ANAK
02/06/2010
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,288 0001601837537 1901012504580002
1802
Alek
PESERTA
15/02/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,289 0001601837548 1901014804580001
1802
Rosmania
ISTRI
07/01/1980
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,290 0001601837559 1901012907870001
1802
Rezza
ANAK
29/07/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,291 0001601837561 1901016707540002
1805
Romli
PESERTA
27/07/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,292 0001601837572 1901015401560004
1805
Suriani
ISTRI
14/01/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,293 0001601837583 1901014109350001
1805
Supiana
TAMBAHAN
01/09/1935
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,294 0001601837605 1901011305680002
1812
Isnain
PESERTA
13/05/1968
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,295 0001601837616 1901015705680005
1812
Rosmala Dewi
ISTRI
17/05/1968
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,296 0001601837627 1901011905950005
1812
Agung Saputra
ANAK
19/05/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,297 0001601837638 1901015605960005
1812
Nur Aziza Dwi
ANAK
16/05/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 187 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,298 0001601837649 1901012606010005
1812
Al Furqon
ANAK
26/06/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,299 0001601837684 1901011907640001
1829
Mukri
PESERTA
19/07/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,300 0001601837695 1901015708640006
1829
Suryana
ISTRI
17/08/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,301 0001601837706 1901010407910001
1829
Julindra
ANAK
04/07/1991
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,302 0001601837717 1901012402940004
1829
Reza
ANAK
24/02/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,303 0001601837728 1901012909060004
1829
Agung Alamsyah
ANAK
29/09/2006
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,304 0001601837739 1901011201430005
1834
Muhammad Saleh
PESERTA
12/01/1943
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,305 0001601837752 1901010509890005
1834
Bambang Sapriyanto Windra
ANAK
05/09/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,306 0001601837774 1901012905880002
1843
Ramdani
PESERTA
29/05/1988
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,307 0001601837829 1901016403460002
1857
Robiah
PESERTA
24/03/1946
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,308 0001601837831 1901011510620004
1857
Abdul Halik
ANAK
15/10/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,309 0001601837842 1901015103670006
1857
Hawati
ANAK
11/03/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,310 0001601837853 1901010709900001
1860
Jon Fedro Effendi
PESERTA
07/12/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,311 0001601837864 1901016209940003
1860
Renita Anggraini
ISTRI
22/09/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,312 0001601837875 1901011210130007
1860
Rafka Dinata
ANAK
12/10/2013
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,313 0001601837886 1901011502420005
1863
Karo Paidjan
PESERTA
15/02/1942
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,314 0001601837897 1901014606450008
1863
Siti Aisyah
ISTRI
06/06/1945
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,315 0001601837908 1901010304720003
1863
Muhammad Erawadi
ANAK
03/04/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,316 0001601837919 1901016802780001
1863
Erti Fatimah
ANAK
28/02/1978
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,317 0001601837921 1901013101530001
1867
Sali
PESERTA
31/01/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,318 0001601837932 1901015204510001
1867
Mini Djumai
ISTRI
12/04/1951
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,319 0001601837943 1901011402620002
1869
Tjhia Cie Cung
PESERTA
14/02/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,320 0001601837987 1901011005800001
1880
Dedy Hendra Boen
PESERTA
10/05/1980
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 188 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,321 0001601837998 1901014509810002
1880
Marlinah
ISTRI
05/09/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,322 0001601838009 1901015505040001
1880
Silvie Chestella
ANAK
15/05/2004
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,323 0001601838011 1901010211090001
1880
Steven Manuel B
ANAK
02/11/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,324 0001601838022 1901014801120001
1880
Jesslyn Vanesya
ANAK
08/01/2012
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,325 0001601838033 1901016009880006
1885
Juliastuti
PESERTA
20/09/1988
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,326 0001601838044 1901016607020004
1885
Leli Mustika
ANAK
26/07/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,327 0001601838055 1901014509090003
1885
Dina Mariana
ANAK
05/09/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,328 0001601838066 1901016309740006
1888
Murni Solo
PESERTA
23/09/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,329 0001601838077 1901012710950004
1888
Tomy Atmaja
ANAK
27/10/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,330 0001601838088 1901015412990001
1888
Puteri
ANAK
14/12/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,331 0001601838099 1803101409690003
1894
Leo Wijaya
PESERTA
14/09/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,332 0001601838101 1803105709700002
1894
Nuryati
ISTRI
17/09/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,333 0001601838112 1803105802950004
1894
Gita Febriana Nurmaya
ANAK
18/02/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,334 0001601838123 1803106901960002
1894
Dian Anjani
ANAK
19/01/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,335 0001601838134 1803102402020003
1894
Hapsiliano Arhanda Ibra Wijaya
ANAK
24/02/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,336 0001601838167 1901015809490001
1904
Tjoe Soei Soen
PESERTA
18/09/1949
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,337 0001601838178 1901014409820001
1904
Eti
ANAK
04/09/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,338 0001601838189 1901012812690002
1906
Hermanto
PESERTA
28/12/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,339 0001601838191 1901015912780001
1906
Eka Setiawan
ISTRI
19/12/1978
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,340 0001601838202 1901016912020004
1906
Dewi
ANAK
29/12/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,341 0001601838213 1901016102100005
1906
Enjelika
ANAK
21/02/2010
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,342 0001601838224 1901010612630001
1910
Kinen
PESERTA
06/12/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,343 0001601838235 1901015605670001
1910
Tjen Ni Ni
ISTRI
16/05/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 189 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,344 0001601838246 1901010902900001
1910
Dody
ANAK
09/02/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,345 0001601838257 1901015911920005
1910
Desy Elisa
ANAK
19/11/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,346 0001601838268 1901011210370001
1914
Phang Kap In
PESERTA
12/10/1937
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,347 0001601838279 1901015103400001
1914
Ropiah
ISTRI
11/03/1940
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,348 0001601838281 1901011907660002
1914
Windi
ANAK
19/07/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,349 0001601838314 1901014602630003
1921
Djap Mie Joen
PESERTA
06/02/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,350 0001601838325 1901010205030004
1921
Harri Wijaya
ANAK
02/05/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,351 0001601838336 1901011201740002
1923
Tjhang Nam Kioe
PESERTA
12/01/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,352 0001601838347 1901015211740004
1923
Ngiat Tjhin
ISTRI
12/11/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,353 0001601838358 1901015312990001
1923
Lidia Christika
ANAK
13/12/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,354 0001601838369 1901011505050004
1923
Celvin Fernando
ANAK
15/05/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,355 0001601838371 1901016903630001
1927
Mie Ling
PESERTA
28/03/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,356 0001601838382 1901012506920001
1927
Sonny
ANAK
25/06/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,357 0001601838393 1901016604970001
1927
Pamalia Sulsila
ANAK
26/04/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,358 0001601838404 1901011411077096
1931
Foe Kiong Men
PESERTA
18/11/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,359 0001601838415 1901012101720006
1931
Foe Foeng Djong
ANAK
21/01/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,360 0001601838437 1901012308360001
1936
Tjhin Djoeng Kwet
PESERTA
23/08/1936
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,361 0001601838459 1901016009560005
1943
Lim A Nja
PESERTA
20/09/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,362 0001601838472 1901016311800001
1945
Mewan
PESERTA
23/11/1980
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,363 0001601838483 1901017006980006
1945
Sela Juniati
ANAK
30/06/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,364 0001601838494 1901012508050006
1945
Ferdi Saputra
ANAK
25/08/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,365 0001601838505 1901012911500001
1948
Tjhin A Khie
PESERTA
29/11/1950
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,366 0001601838516 1901014110580003
1948
Tjen Mi Sun
ISTRI
01/10/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 190 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,367 0001601838527 1901015003200001
1948
Phung A Djam
TAMBAHAN
10/03/1920
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,368 0001601838538 1901010409420001
1954
Harianto Ngiswadi
PESERTA
04/09/1942
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,369 0001601838549 1901016608570001
1954
Then Khioek Joen
ISTRI
26/08/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,370 0001601838551 1901014905610001
1956
Liu A Non
PESERTA
09/05/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,371 0001601838562 1901015106890001
1956
Rita
ANAK
11/06/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,372 0001601838573 1901015606900002
1956
Lia
ANAK
16/06/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,373 0001601838584 1901012206530002
1959
Djong Moek Sioe
PESERTA
22/08/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,374 0001601838595 1901012312890004
1959
Andri Tanzania
ANAK
23/12/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,375 0001601838606 1901011806920006
1959
Johannes Hartono
ANAK
18/06/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,376 0001601838639 1901015103630001
1968
Liauw Nyoek Sian
PESERTA
11/03/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,377 0001601838641 1901012312940006
1968
Erwin Sutajo
ANAK
23/12/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,378 0001601838652 1901012204980003
1968
Hendri Sugiarto
ANAK
22/04/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,379 0001601838663 1901010610000001
1968
Devis Surijanno
ANAK
06/10/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,380 0001601838674 1901016112030002
1968
Dela Anggita Natalia
ANAK
21/12/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,381 0001601838685 1901010909700008
1973
Sugianto
PESERTA
09/09/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,382 0001601838696 1901016502770003
1973
Endang Ratnawati
ISTRI
25/09/1977
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,383 0001601838707 1901010812550001
1976
Sadikin Tuhir
PESERTA
08/12/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,384 0001601838718 1901014809740002
1976
Tjomie
ISTRI
08/09/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,385 0001601838729 1901010108980009
1976
Reza Gustama Tuhir
ANAK
01/08/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,386 0001601838731 1901013005520001
1979
Hie Lip Khiong
PESERTA
30/05/1952
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,387 0001601838742 1901016206520001
1979
Fatilah
ISTRI
22/06/1952
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,388 0001601838753 1901010712630001
1981
Abdullah
PESERTA
07/12/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,389 0001601838775 1901010307820004
1991
Sudarto
PESERTA
03/07/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 191 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,390 0001601838786 1901016406870006
1991
Yunita
ISTRI
24/06/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,391 0001601838797 1901012611090001
1991
Stevenlim
ANAK
26/11/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,392 0001601838808 1901012502930001
1994
Jumadi
PESERTA
25/02/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,393 0001601838819 1901014810960006
1994
Desi Arisa
ISTRI
08/10/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,394 0001601838821 1901010809540001
1996
Bong Kian Djung
PESERTA
08/09/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,395 0001601838832 1901016605560001
1996
Bong Non Lie
TAMBAHAN
26/05/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,396 0001601838843 1901015209620001
1998
Mie Lie
PESERTA
12/09/1952
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,397 0001601838854 1901016502770002
2006
Komariah
PESERTA
25/02/1977
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,398 0001601838865 1901015612000005
2006
Desca Utami
ANAK
16/12/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,399 0001601838876 1901010803050002
2006
Dimas Saputra
ANAK
08/03/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,400 0001601838909 1901010807750004
2220
Muhammad Juliadi
PESERTA
08/07/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,401 0001601838911 1901016310840001
2220
Rohana
ISTRI
23/10/1984
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,402 0001601838922 1901015103070003
2220
Della Puspita Sari
ANAK
11/03/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,403 0001601838933 1901010606830003
2224
Rudymanto
PESERTA
06/08/1983
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,404 0001601838944 1901014709880006
2224
Fenniwati
ISTRI
07/09/1988
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,405 0001601838955 1901010108070009
2224
Fandy Aufan Syah Lo
ANAK
01/08/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,406 0001601838966 1901016105120003
2224
Sherin Meishella Angraini Lo
ANAK
21/05/2012
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,407 0001601838977 1901016103570000
2228
Rina
PESERTA
21/03/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,408 0001601838988 1901012208610002
2229
Zaidan
PESERTA
22/08/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,409 0001601838999 1901014405650002
2229
Lilik Mujiati
ISTRI
04/05/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,410 0001601839001 1901015307910004
2229
Sari Yulianti
ANAK
13/07/1991
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,411 0001601839012 1901012303930005
2229
Oom Ismi Mustaqim
ANAK
23/03/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,412 0001601839023 1901011034630004
2233
Candra Annanto
PESERTA
03/04/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 192 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,413 0001601839034 1901015308760006
2233
Nunawaty
ISTRI
13/08/1976
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,414 0001601839045 1901012112680003
2240
R. PUJI HARTO
PESERTA
21/12/1968
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,415 0001601839056 1901017009010004
2240
SEPA APRIANTI
ANAK
30/09/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,416 0001601839067 1901012908750001
2243
ARGUS
PESERTA
29/08/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,417 0001601839078 1901014409810001
2243
JAMALIA
ISTRI
09/04/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,418 0001601839089 1901011310030001
2243
ARMANSYAH
ANAK
13/10/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,419 0001601839091 1901010101420008
2246
UMAR AR
PESERTA
01/01/1942
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,420 0001601839102 1901011602790001
2248
RIDUAN
PESERTA
16/02/1979
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,421 0001601839113 1901015709580005
2249
WATI
PESERTA
17/09/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,422 0001601839124 1901011209820003
2253
SYAFFRIADI
PESERTA
09/12/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,423 0001601839135 1901014804770007
2255
LISNAINI
PESERTA
04/08/1977
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,424 0001601839146 1901012412860004
2255
BAMBANG IRAWAN
ANAK
24/12/1986
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,425 0001601839157 1901010510560004
2258
NAZARUDIN
PESERTA
10/05/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,426 0001601839168 1901011602820001
2258
FERRY
ANAK
16/02/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,427 0001601839179 1901011008040001
2258
PUTRA
ANAK
08/10/2004
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,428 0001601839181 1901014310510001
2262
SULASTRI
PESERTA
10/03/1951
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,429 0001601839192 1901013112700001
2271
MOHAMMAD IRSAN
PESERTA
31/12/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,430 0001601839203 1901012309520003
2272
SURYANTO
PESERTA
23/09/1952
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,431 0001601839214 1901017108700002
2274
NAYUT
PESERTA
31/08/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,432 0001601839225 1901015607470001
2275
SAKIAH
PESERTA
16/07/1947
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,433 0001601839236 1901010811740007
2275
ZULFIKAR
ANAK
11/08/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,434 0001601839247 1901014403830004
2278
DIAN DAYATRI
PESERTA
03/04/1983
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,435 0001601839258 1901012310670004
2281
EDDY HARIYANTO
PESERTA
23/10/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 193 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,436 0001601839269 1905035607710001
2281
NITA WATI
ISTRI
16/07/1971
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,437 0001601839271 1901012804000006
2281
SALMAN
ANAK
28/04/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,438 0001601839282 1901014409400001
2285
ZUNIAR
PESERTA
09/04/1940
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,439 0001601839293 1901014503660002
2285
HENNI
ANAK
06/03/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,440 0001601839304 1901010607500001
2288
SURATMAN
PESERTA
07/06/1950
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,441 0001601839326 1901015510430003
2290
SOLEHA
PESERTA
15/10/1943
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,442 0001601839337 1901016107540001
2291
JAMILAH
PESERTA
21/07/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,443 0001601839348 1901010802370001
2306
GHOFAR
PESERTA
02/08/1937
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,444 0001601839359 1901015409510002
2307
SILA
PESERTA
14/09/1951
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,445 0001601839361 1901011509870004
2307
DISKA
ANAK
15/09/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,446 0001601839372 1901011409390001
2311
AGUS SYAMSIR
PESERTA
14/09/1939
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,447 0001601839383 1901017112420007
2311
MARYAM
ISTRI
31/12/1942
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,448 0001601839394 1901011508490002
2313
ANWAR MUHAMAD
PESERTA
15/08/1949
HAMIDAH MEDIKA CLINIC
01/01/2015
AKTIF
19,225
30/12/2014
4,449 0001601839405 1901015102570002
2315
ERNA
PESERTA
02/11/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,450 0001601839416 1901015404720001
2315
ZURIAH
TAMBAHAN
14/04/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,451 0001601839427 1901016005590002
2317
TALISNA
PESERTA
20/05/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,452 0001601839438 1901055510600001
2318
HERMILIA
PESERTA
15/10/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,453 0001601839449 1901016705810004
2320
YULFITA
PESERTA
27/05/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,454 0001601839451 1901017003690002
2323
CAHYARI RAHMADHON
PESERTA
22/02/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,455 0001601839462 1901012202930001
2323
NURHAYA NOVA LIYANTI
ANAK
27/11/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,456 0001601839473 1901016711960001
2323
SAFIRA NOFITRIYANI
ANAK
11/07/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,457 0001601839484 1901014711050002
2326
SUHELMI
PESERTA
02/10/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,458 0001601839495 1901011002560002
2326
RAHMAWATI
ISTRI
19/01/1988
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 194 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,459 0001601839506 1901015901880001
2326
PENI
ANAK
01/05/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,460 0001601839517 1901014501060006
2326
WINDA
ANAK
22/06/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,461 0001601839528 1901016206070006
2326
MUHAMMAD JULIANSYAH
ANAK
07/02/2012
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,462 0001601839539 1901010207120003
2331
SAMAN LAMBOGE
PESERTA
29/09/1945
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,463 0001601839541 1901012909450001
2331
ZUBAIDAH
ISTRI
26/05/1949
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,464 0001601839552 1901016605490001
2331
ARVITA SARI
ANAK
20/04/1978
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,465 0001601839563 1901016004780001
2331
VERA LESTARI
ANAK
02/02/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,466 0001601839574 1901014202850011
2335
HALIYAH
PESERTA
07/12/1942
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,467 0001601839585 1901015207420001
2336
ROMLAN
PESERTA
15/06/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,468 0001601839596 1901011506580004
2337
ZULMAL
PESERTA
23/08/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,469 0001601839607 1901012210910006
2340
URYATINI
PESERTA
02/04/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,470 0001601839618 1901014402600008
2340
DYCKA ANUGRAH DEWANGGA ANAK
15/06/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,471 0001601839629 1901014706410002
2343
BAMBANG HERMANTO
PESERTA
10/05/1968
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,472 0001601839631 1901010510680005
2343
ROSITA
ISTRI
08/09/1977
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,473 0001601839642 1901014908770008
2343
BUDIANTO
ANAK
04/03/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,474 0001601839653 1901010304970003
2343
KURNIAWATI
ANAK
14/05/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,475 0001601839664 1901015405010002
2343
FERDI DIAN SAPUTRA
ANAK
11/12/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,476 0001601839675 1901011211050003
2343
HAFIZZAH
ANAK
05/09/2010
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,477 0001601839686 1901014905100004
2349
FAZIL SUBIANTO
PESERTA
02/03/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,478 0001601839697 1901010302590001
2350
ANITA
PESERTA
30/11/1951
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,479 0001601839708 1901015011500002
2351
SRI GUSTINAR
PESERTA
08/08/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,480 0001601839719 1901015209690001
2351
SRI FERNANDO
ANAK
02/05/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,481 0001601839721 1901010502930000
2351
SRI ODI KURNIAWAN
ANAK
25/10/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 195 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,482 0001601839732 1901012510960001
2351
SRI SUTAN ADITIYA
ANAK
21/04/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,483 0001601839743 1901012104050003
2351
SRI M FIRLI
ANAK
02/05/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,484 0001601839754 1901010502070001
2357
ASMAWANI
PESERTA
26/08/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,485 0001601839765 1901016608620001
2357
SHERLY ADITYA
ANAK
01/05/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,486 0001601839776 1901014501940003
2359
DIDI ZULIADI
PESERTA
08/07/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,487 0001601839787 1605175104870004
2360
APRILLIZA MAWADDAH EP
PESERTA
04/11/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,488 0001601839798 1905175104870004
2360
ANNISA EKA PUTRI
ANAK
09/04/2012
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,489 0001601839809 1901014409120003
2362
BAMBANG SABIANA
PESERTA
18/03/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,490 0001601839811 1901010302910002
2362
NAUFAL FAHARZI
ANAK
11/05/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,491 0001601839822 1901016301990001
2362
SUSANTI
TAMBAHAN
23/12/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,492 0001601839833 1901016312610002
2368
JUMHARI
PESERTA
07/01/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,493 0001601839844 1901010107610028
2369
LISRIANI
PESERTA
14/11/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,494 0001601839855 1901014502580001
2376
AZESTRA
PESERTA
12/03/1991
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,495 0001601839866 1901010312910001
2377
TJHIN A CAI
PESERTA
24/08/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,496 0001601839877 1901016408530002
2377
TJHIN A HAK
ANAK
05/11/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,497 0001601839888 1901011105730001
2377
TJHIN A SAK
ANAK
22/04/1978
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,498 0001601839899 1901012204780002
2377
HENDI OKTARI CO SANDY
ANAK
22/01/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,499 0001601839901 1901011608610002
2382
TJHIE DJUN LAI
PESERTA
23/03/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,500 0001601839912 1901012303630005
2382
LIOE MUK SIN
ISTRI
22/04/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,501 0001601839923 1901016204720002
2382
SHERLY EILEENLEE
ANAK
06/11/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,502 0001601839934 1901015106970003
2382
SHELLY HELEN
ANAK
23/04/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,503 0001601839945 1901016304000003
2382
VALENCIA LYRA
ANAK
11/08/2006
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,504 0001601839956 1901014611060001
2387
TJHIE DJUN SIONG
PESERTA
16/02/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 196 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,505 0001601839967 1901011602590001
2387
DJONG TJAUW NJONG
ISTRI
23/07/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,506 0001601839978 1901016307530005
2387
EDDY HARIYANTO
ANAK
03/01/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,507 0001601839989 1901011411890002
2387
FEBRY
ANAK
13/02/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,508 0001601839991 1901011302920001
2393
SUHARDI
PESERTA
08/08/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,509 0001601840002 1901017006610001
2393
MELENIA DITA SARI
ANAK
21/05/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,510 0001601840013 1901016105000002
2393
SEPGIANTO
ANAK
09/11/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,511 0001601840024 1901011109020003
2397
BAN KIM KHIN
PESERTA
10/07/1937
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,512 0001601840035 1901010710370001
2397
NG KHUN SAK
ANAK
28/10/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,513 0001601840046 1901016810720001
2399
SURDJINAH
PESERTA
12/09/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,514 0001601840057 1901014912620002
2399
SURJANI
TAMBAHAN
23/01/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,515 0001601840068 1901015110840004
2402
YUNI LILI
PESERTA
10/11/1984
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,516 0001601840079 1901015110840003
2403
TJONG MUK FA
PESERTA
01/05/1928
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,517 0001601840081 1901010501280001
2403
LO A LIONG
ANAK
06/06/1946
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,518 0001601840092 1901014606460001
2405
ROHANI
PESERTA
31/03/1950
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,519 0001601840103 1901011403350002
2408
BOEN SUN KIUN
PESERTA
07/12/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,520 0001601840114 1901011207600003
2408
NGUI FOBI TJIN
ISTRI
08/09/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,521 0001601840125 1901014908590001
2408
NGOEI NAM KWET
TAMBAHAN
29/06/1927
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,522 0001601840136 1901012906270001
2411
TJEN JIN NIE
PESERTA
21/05/1950
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,523 0001601840147 1901016105500001
2411
SUSIASIN
ANAK
03/02/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,524 0001601840158 1901014203870013
2411
EKO SUSANTO
ANAK
01/01/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,525 0001601840169 1901010101940009
2414
BONG KWET NGIAN
PESERTA
27/04/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,526 0001601840171 1901012704540001
2414
TJONG MIE RIE
ISTRI
17/02/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,527 0001601840182 1901015702590001
2414
TJONG KON FUNG
TAMBAHAN
09/07/1922
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 197 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,528 0001601840193 1901014709220001
2417
SAAT
PESERTA
03/12/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,529 0001601840204 1901011203890006
2418
TJEN A KIM
PESERTA
02/03/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,530 0001601840215 1901010302590002
2419
SYOUFURO
PESERTA
05/03/1940
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,531 0001601840226 1901014305400002
2419
FARTONA
ANAK
22/06/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,532 0001601840237 1901015208650008
2421
NUNUNG NURHAYATI
PESERTA
08/12/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,533 0001601840248 1901014701980023
2422
ELA TRIANA
PESERTA
01/07/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,534 0001601840259 1901015108720003
2423
MARLIYAH
PESERTA
08/11/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,535 0001601840261 1901016405960002
2423
LENI MARDIANA
ANAK
24/05/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,536 0001601840272 1901015102010001
2423
CHRISTINA
ANAK
02/11/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,537 0001601840283 1901016702510002
2426
PHUNG A MOI
PESERTA
27/02/1951
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,538 0001601840294 1901010303820010
2426
WE WE
ANAK
03/03/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,539 0001601840305 1901010303820011
2426
SING SING
ANAK
03/03/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,540 0001601840316 1901014105490001
2429
JOHANA ROSANA
PESERTA
05/01/1949
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,541 0001601840327 1901015609830002
2429
RUTH APRIYANI SAULINA
ANAK
16/09/1983
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,542 0001601840338 1901012809870003
2429
SAMUEL
ANAK
28/09/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,543 0001601840349 1901016104190001
2432
MINA BUDIMAN
PESERTA
21/04/1919
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,544 0001601840351 1901011207750003
2434
ARI SUSANTO
PESERTA
07/12/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,545 0001601840362 1901015109750002
2434
SULASTRI
ISTRI
09/11/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,546 0001601840373 1901014912070002
2434
NAVRA WULANDARI
ANAK
12/09/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,547 0001601840384 1901015709670001
2438
HALIZA
PESERTA
17/09/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,548 0001601840395 1901015812970002
2438
RATNA DEWI
ANAK
16/12/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,549 0001601840406 1901014311000001
2438
KHANA MORINAGA
ANAK
11/03/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,550 0001601840417 1901012007590001
2441
MUCHTASYIM
PESERTA
20/07/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 198 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,551 0001601840428 1901014205600001
2441
NGADINAH
ISTRI
05/02/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,552 0001601840439 1901016008560002
2443
SURIDA
PESERTA
20/08/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,553 0001601840441 1901016608490002
2444
LIE NGIM SUI
PESERTA
26/06/1949
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,554 0001601840452 1901012606900004
2444
JUNAIDI
ANAK
26/06/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,555 0001601840463 1901010409590001
2446
DJIU TJIU FO
PESERTA
09/04/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,556 0001601840474 1901016801870003
2446
DEWI SUSANTI
ANAK
28/01/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,557 0001601840485 1901015404820007
2449
SIAU SIA
PESERTA
14/04/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,558 0001601840496 1901016608040003
2449
VEREN VERONICA
TAMBAHAN
26/08/2004
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,559 0001601840507 1901014409060003
2449
KIARA VIORINE
TAMBAHAN
09/04/2006
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,560 0001601840518 1901012211720008
2452
DJUNG HON
PESERTA
22/11/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,561 0001601840529 1901016207770006
2452
THUNG NGIN AI
ISTRI
22/07/1977
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,562 0001601840531 1901011407990005
2452
NICO SAPUTRA
ANAK
14/07/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,563 0001601840542 1901010708010004
2452
RICKY SETIAWAN
ANAK
08/07/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,564 0001601840553 1901016312490002
2456
MAINA BAKAR
PESERTA
23/12/1949
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,565 0001601840564 1901012810920004
2462
DEDY SETIAWAN
PESERTA
28/10/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,566 0001601840575 1901011802840005
2464
HENDRA
PESERTA
18/02/1984
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,567 0001601840586 1901055005860001
2464
MARLINA
ISTRI
05/10/1986
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,568 0001601840597 1901010607040008
2464
ANTON WIJAYA
ANAK
07/06/2004
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,569 0001601840608 1901010111120004
2464
RAFAEL MAHENDRA NOVE
ANAK
11/01/2012
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,570 0001601840619 1901012911020001
2472
RIKO
PESERTA
29/11/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,571 0001601840621 7404100107650049
2489
LA MUSLIMIN
PESERTA
07/01/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,572 0001601840632 1901010808480004
2490
SUKARDI AWI
PESERTA
08/08/1948
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,573 0001601840643 1901016808630003
2490
RUSNIATI
ISTRI
28/08/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 199 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,574 0001601840654 1901015807860005
2490
SRI YUNIARTI
ANAK
18/07/1986
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,575 0001601840665 1901014507030003
2490
DHEA INDRA LORENZA
ANAK
07/05/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,576 0001601840676 1901016003120001
2490
NAYLA
TAMBAHAN
20/03/2012
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,577 0001601840687 1901013112880009
2497
RUSTAM
PESERTA
31/12/1988
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,578 0001601840698 1901014803560001
2498
WA ODE AWINE
PESERTA
03/08/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,579 0001601840709 1901010107860026
2498
YUSRAN
ANAK
07/01/1986
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,580 0001601840711 1901010908460003
2500
LA ODE BA'U
PESERTA
08/09/1946
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,581 0001601840722 1901010904640002
2501
ALHUD
PESERTA
04/09/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,582 0001601840733 1901016307660002
2501
SUKARMI
ISTRI
23/07/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,583 0001601840744 1901011202970003
2501
ALDRIAN MIRANDA
ANAK
02/12/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,584 0001601840755 1901016703980008
2501
VONIKA ALDEA
ANAK
27/03/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,585 0001601840766 1901015611660001
2505
SINA
PESERTA
16/11/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,586 0001601840777 1901014707340002
2506
SITI SOLEHA
PESERTA
07/07/1934
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,587 0001601840788 1901010711700004
2507
TESKO
PESERTA
11/07/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,588 0001601840799 1901015204750004
2507
WAYANA
ISTRI
04/12/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,589 0001601840801 1901015701020001
2507
RISKA EMBUN DINI
ANAK
17/01/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,590 0001601840812 1901015601090002
2507
DINA ARIANI
ANAK
16/01/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,591 0001601840823 1901015601090003
2507
DITA ARIANTI
ANAK
16/01/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,592 0001601840834 1901014510470001
2512
ALNAH
PESERTA
10/05/1947
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,593 0001601840845 1901010908790007
2512
ROMLAN
ANAK
08/09/1979
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,594 0001601840856 1901011503420001
2514
BAKJAH
PESERTA
15/03/1942
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,595 0001601840867 1901011512730001
2514
WAHYUDI
ANAK
15/12/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,596 0001601840878 1901011203740003
2516
FAUZI
PESERTA
03/12/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 200 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,597 0001601840889 1901010802540004
2517
WARDOYO.K
PESERTA
02/08/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,598 0001601840891 1901015712600004
2517
JURIAH
ISTRI
17/12/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,599 0001601840902 1901012001810011
2517
MARIO
ANAK
20/01/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,600 0001601840913 1901011506580003
2520
KASIM
PESERTA
15/06/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,601 0001601840924 1901013003030003
2525
STEVY CLARISTA
PESERTA
30/03/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,602 0001601840935 1901012510610002
2526
WILDANI
PESERTA
25/10/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,603 0001601840946 1901011904900004
2526
ROMADON
ANAK
19/04/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,604 0001601840957 1901016005930002
2526
RAMONA
ANAK
20/05/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,605 0001601840968 1901012009470001
2530
MANG UNING
PESERTA
20/09/1947
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,606 0001601840979 1901012806000002
2530
RAMA
ANAK
28/06/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,607 0001601840981 1901016904020004
2530
RITA
ANAK
29/04/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,608 0001601840992 1901016403750003
2535
Rahmadiah
PESERTA
24/03/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,609 0001601841003 1901016505320003
2535
Rosi
TAMBAHAN
25/05/1932
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,610 0001601841014 1901014803610002
2540
Tampa
PESERTA
03/08/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,611 0001601841025 1901011204000005
2540
Riski Pratama
ANAK
04/12/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,612 0001601841036 1901014103340001
2540
Rinang
TAMBAHAN
03/01/1934
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,613 0001601841047 1901016304560004
2543
Mia
PESERTA
23/04/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,614 0001601841058 1901011201820003
2543
Andi Tanra
ANAK
01/12/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,615 0001601841069 1901014508010007
2543
Andi Tenri
ANAK
08/05/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,616 0001601841071 1901015510400001
2543
Jusni
TAMBAHAN
15/10/1940
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,617 0001601841082 1901012105550001
2547
Abu Bakar
PESERTA
21/05/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,618 0001601841093 1901014707700004
2547
Marwa
ISTRI
07/07/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,619 0001601841104 1901011403890002
2547
Emang
ANAK
14/03/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 201 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,620 0001601841115 1901011608960001
2547
BAHARUDIN
ANAK
18/08/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,621 0001601841126 1901011507990006
2547
Amirudin
ANAK
15/07/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,622 0001601841137 1901015809010002
2547
Shinta
ANAK
18/09/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,623 0001601841148 1901016103610004
2553
Kartini
PESERTA
21/03/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,624 0001601841159 1901014203970003
2553
Putri Lastri
ANAK
03/02/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,625 0001601841161 1901015301040001
2553
Putri Mindasari
ANAK
13/01/2004
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,626 0001601841172 1901010107590010
2553
Nurdin
TAMBAHAN
07/01/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,627 0001601841194 1901011203700007
2558
Jabar M. Ali
PESERTA
03/12/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,628 0001601841205 1901014607800009
2558
Kamridah
ISTRI
07/05/1980
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,629 0001601841216 1901012107010004
2558
Hamza Ali
ANAK
21/07/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,630 0001601841227 1901012205050006
2558
Nasrullah
ANAK
22/05/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,631 0001601841238 1901011409090005
2558
Saipul Alamsya
ANAK
14/09/2009
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,632 0001601841249 1901015507370002
2558
Monro
TAMBAHAN
15/07/1937
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,633 0001601841251 1901014911780002
2564
Darmawati
PESERTA
11/09/1978
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,634 0001601841262 1901010705990002
2564
Jumardi
ANAK
05/07/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,635 0001601841273 1901016409020004
2564
Vira Damayanti
ANAK
24/09/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,636 0001601841284 1901012112620003
2567
Amiruddin
PESERTA
21/12/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,637 0001601841295 1901016604660002
2567
Rosdiana
ISTRI
25/04/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,638 0001601841306 1901012601910011
2567
Arfiyandi
ANAK
28/01/1991
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,639 0001601841317 1901010504930007
2567
Andryadi
ANAK
04/03/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,640 0001601841328 1901014509430002
2567
Sittiha Daeng Malate
TAMBAHAN
08/05/1943
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,641 0001601841339 1901014212500001
2573
Siti Rahma
PESERTA
12/02/1950
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,642 0001601841341 1901014512790002
2573
Dahlia
ANAK
12/05/1979
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 202 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,643 0001601841352 1901012906890006
2573
Roy Yanto
ANAK
29/06/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,644 0001601841363 1901011803920003
2573
Mardianto
ANAK
18/03/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,645 0001601841374 1901011910970005
2573
Yuda Prayoga
ANAK
19/10/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,646 0001601841385 1901015212670005
2578
Mardiana
PESERTA
12/12/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,647 0001601841396 1901010506750003
2579
Kahar
PESERTA
06/05/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,648 0001601841407 1901014411840008
2579
Hana
ISTRI
11/04/1984
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,649 0001601841418 1901016811020002
2579
Fadhilah Haevina
ANAK
28/11/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,650 0001601841429 1901015703070002
2579
Debyka Cyntia Mahar
ANAK
17/03/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,651 0001601841431 1901011703300001
2583
Amir
PESERTA
17/03/1930
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,652 0001601841442 1901014107360006
2583
Saudah
ISTRI
07/01/1936
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,653 0001601841453 1901015004770004
2583
Rosita
ANAK
04/10/1977
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,654 0001601841464 1901010510530001
2586
Petta Gassing
PESERTA
10/05/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,655 0001601841475 1901014911860002
2586
Nita
ANAK
10/09/1986
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,656 0001601841486 1901014402920002
2586
Wulandari
TAMBAHAN
02/04/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,657 0001601841497 1901013008770004
2589
Dasa Wijaya
PESERTA
30/08/1977
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,658 0001601841508 1901014606820012
2589
Lina
ISTRI
06/06/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,659 0001601841519 1901011004000007
2589
Muhardy Ridwansyah
ANAK
04/10/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,660 0001601841521 1901014601030002
2589
Yessi Liliana
ANAK
01/06/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,661 0001601841532 1901014903040002
2589
Fifi Mareta
ANAK
03/09/2004
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,662 0001601841543 1901010706070001
2589
Santoso
ANAK
06/07/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,663 0001601841554 1901016607080002
2589
Dawiya
ANAK
26/07/2008
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,664 0001601841565 1901010603470001
2596
Toba Bin Bedu
PESERTA
03/06/1947
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,665 0001601841576 1901015004490004
2596
Enni Binti Lamba
ISTRI
04/10/1949
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 203 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,666 0001601841587 1901011003750005
2596
Antonius Bin Toba
ANAK
03/10/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,667 0001601841598 1901011904800008
2599
Heryanto
PESERTA
19/04/1980
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,668 0001601841609 1901015704780001
2599
Kardina. S
ISTRI
17/04/1978
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,669 0001601841611 1901016010110003
2599
Firzanah Salsabila
ANAK
20/10/2011
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,670 0001601841622 1901011002610001
2602
Rahmat Bin Akmal
PESERTA
02/10/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,671 0001601841633 1901016512730002
2602
Nurida Laila
ISTRI
25/12/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,672 0001601841644 1901010506920004
2602
Muhammad Nasir
ANAK
06/05/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,673 0001601841655 1901014811940003
2602
Masnah
ANAK
11/06/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,674 0001601841666 1901010909960006
2602
Muhlis Saputra
ANAK
09/09/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,675 0001601841677 1901015403440001
2602
Kalessong
TAMBAHAN
14/03/1944
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,676 0001601841688 1901012006570004
2608
Jibek
PESERTA
20/06/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,677 0001601841699 1901014305600002
2608
Nurung
ISTRI
05/03/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,678 0001601841701 1901010602810004
2608
Andu
ANAK
02/06/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,679 0001601841712 1901010101620004
2611
Kadir
PESERTA
01/01/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,680 0001601841723 1901014203790002
2611
Aminah
ISTRI
03/02/1979
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,681 0001601841734 1901012606970002
2611
Olfi Mardianto
ANAK
26/06/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,682 0001601841745 1901011006980007
2611
Erer Mardianto
ANAK
06/10/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,683 0001601841756 1901010105010006
2611
Susanto
ANAK
05/01/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,684 0001601841767 1901012504020003
2611
Pitto
ANAK
25/04/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,685 0001601841778 1901016711050002
2611
Serli Mardiana
ANAK
27/11/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,686 0001601841789 1901015501640003
2618
Mawe
PESERTA
15/01/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,687 0001601841791 1901010707880002
2618
Riki Kuswoyo
ANAK
07/07/1988
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,688 0001601841802 1901010103730005
2620
Maming
PESERTA
03/01/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 204 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,689 0001601841813 1901014803450001
2622
Samidah
PESERTA
03/08/1945
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,690 0001601841824 1901010212750003
2622
Jumardi
ANAK
12/02/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,691 0001601841835 1901011002600002
2624
Otte
PESERTA
02/10/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,692 0001601841846 1901014402620001
2624
Rania
TAMBAHAN
02/04/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,693 0001601841857 1901010603690005
2626
Liming
PESERTA
03/06/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,694 0001601841868 1901014202800004
2626
Dewita
ISTRI
02/02/1980
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,695 0001601841879 1901010705020002
2626
Irvan Saputra
ANAK
05/07/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,696 0001601841881 1901014211500001
2626
Umajah
TAMBAHAN
11/02/1950
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,697 0001601841892 1901014107510001
2630
Nuheriah
PESERTA
07/01/1951
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,698 0001601841903 1901010107620001
2630
Dianto
ANAK
07/01/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,699 0001601841914 1901014101430005
2632
Umi Kalsum
PESERTA
01/01/1943
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,700 0001601841925 1901015312860003
2632
Zubaidah
ANAK
13/12/1986
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,701 0001601841936 1901016007900001
2632
Haniah
ANAK
20/07/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,702 0001601841947 1901017112540009
2635
Minah
PESERTA
31/12/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,703 0001601841958 1901012803930005
2635
Firmansah
ANAK
28/03/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,704 0001601841969 1901013003950003
2635
Rivandi
ANAK
30/03/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,705 0001601841971 1901010107560021
2638
Bihek
PESERTA
07/01/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,706 0001601841982 1901017112560011
2638
Selama
ISTRI
31/12/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,707 0001601841993 1901012211940001
2638
Pendi
ANAK
20/11/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,708 0001601842004 1901011907500001
2641
Ibrahim Yunus
PESERTA
19/07/1950
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,709 0001601842015 1901015205610001
2641
Murni
ISTRI
05/12/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,710 0001601842026 1901012901990001
2641
Rico Suryadi
ANAK
29/01/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,711 0001601842037 1901014205460001
2641
Hamisa
TAMBAHAN
05/02/1946
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 205 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,712 0001601842048 1901014701530010
2646
Sukaina
PESERTA
24/01/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,713 0001601842059 1901010701830008
2646
Zainal Abidin
ANAK
01/07/1983
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,714 0001601842061 1901015004840002
2649
Santi
PESERTA
04/10/1984
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,715 0001601842072 1901015707030001
2649
Ayudiansari
ANAK
17/07/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,716 0001601842083 1901015302070001
2649
Adinda Saputri
ANAK
13/02/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,717 0001601842094 1901016409560002
2652
Atira
PESERTA
24/09/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,718 0001601842105 1901011210540002
2653
Djupri
PESERTA
10/12/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,719 0001601842116 1901014805670004
2653
Halipa
ISTRI
05/08/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,720 0001601842127 1901012907870007
2653
Jamaludin
ANAK
29/07/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,721 0001601842138 1901015509950004
2653
Masamanara
ANAK
15/09/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,722 0001601842149 1901011301700001
2657
Efendi
PESERTA
13/01/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,723 0001601842151 1901014512780005
2657
Jumaria
ISTRI
12/05/1978
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,724 0001601842162 1901011505940002
2657
Ajil Saputra
ANAK
15/05/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,725 0001601842173 1901015707030003
2657
Ulandari
ANAK
17/07/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,726 0001601842184 1901014503570004
2657
Darini
TAMBAHAN
03/05/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,727 0001601842195 1901015011660002
2663
Suryati
PESERTA
11/10/1950
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,728 0001601842206 1901012709970006
2663
Finky Afriandi
ANAK
27/09/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,729 0001601842217 1901011302000002
2663
Arif
ANAK
13/02/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,730 0001601842228 1901011402630003
2666
Asis
PESERTA
14/02/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,731 0001601842239 1901014601730001
2666
Nurlela
ISTRI
01/06/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,732 0001601842241 1901015908010002
2666
Meli Agusti
ANAK
19/08/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,733 0001601842252 1901012701070005
2666
Jefriyadi.S
ANAK
27/01/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,734 0001601842263 1901017010620002
2666
Tantu
TAMBAHAN
30/10/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 206 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,735 0001601842274 1901011112890001
2666
Ambo Intan
TAMBAHAN
12/11/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,736 0001601842285 1901010709240001
2672
Sessu
PESERTA
09/07/1924
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,737 0001601842296 1901012304780001
2672
M.Amin
ANAK
23/04/1978
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,738 0001601842307 1901010412850001
2672
M.Yusup
ANAK
12/04/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,739 0001601842318 1901010107890001
2672
Ruslan
TAMBAHAN
07/01/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,740 0001601842329 1901010504780007
2677
Basri
PESERTA
04/05/1978
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,741 0001601842331 1901015311820005
2677
Ina
ISTRI
13/11/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,742 0001601842342 1901016701010000
2677
Indri
ANAK
27/01/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,743 0001601842353 1901011809020004
2677
M. Sandy
ANAK
18/09/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,744 0001601842364 1901014101430006
2677
Kasaturi
TAMBAHAN
01/01/1943
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,745 0001601842375 1901011402600003
2682
Asse
PESERTA
14/02/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,746 0001601842386 1901015208650006
2682
Nukeria
ISTRI
08/12/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,747 0001601842397 1901014208520003
2684
Maimunah
PESERTA
08/02/1952
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,748 0001601842408 1901011810810005
2684
Firdaus
ANAK
18/10/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,749 0001601842419 1901011007680002
2689
Bustan
PESERTA
07/10/1968
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,750 0001601842421 1901015010730007
2689
Ratna juita
ISTRI
10/10/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,751 0001601842432 1901011306990002
2689
Febriyansyah
ANAK
13/06/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,752 0001601842443 1901015505050002
2689
Flora Sita
ANAK
15/05/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,753 0001601842454 1901014107290006
2689
Nengsi
TAMBAHAN
21/07/1929
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,754 0001601842465 1901010104840004
2689
Sopiyan
TAMBAHAN
01/04/1984
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,755 0001601842476 1901011208470001
2696
ABD. Halim
PESERTA
08/12/1947
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,756 0001601842487 1901016202630001
2696
Hasma
ISTRI
22/02/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,757 0001601842498 1901014909940001
2696
Jumarsih
ANAK
09/09/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 207 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,758 0001601842509 1901014812630004
2699
Tina
PESERTA
12/08/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,759 0001601842511 1901014807920002
2699
Paramita
ANAK
07/08/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,760 0001601842522 1901012805000004
2699
Wahyudi
ANAK
28/05/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,761 0001601842533 1901011404520002
2702
Sukarmin M. Nuh
PESERTA
14/04/1952
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,762 0001601842544 1901015403580001
2702
Munarsi
ISTRI
14/03/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,763 0001601842555 1901011910870006
2702
Hebby Hermansyah
ANAK
19/10/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,764 0001601842566 1901011303600002
2705
Suryadi
PESERTA
13/03/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,765 0001601842577 1901015704670001
2705
Lina
ISTRI
17/04/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,766 0001601842588 1901015010570004
2707
Rasmi Intan
PESERTA
10/10/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,767 0001601842599 1901011006790001
2707
Mustarmizi
ANAK
06/10/1979
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,768 0001601842601 1901011808840004
2707
Agus Supriatna
ANAK
18/08/1984
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,769 0001601842612 1901010101860003
2707
Jeri Hasvandi
ANAK
01/01/1986
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,770 0001601842623 1901015708880003
2707
Agus Triyana
ANAK
17/08/1988
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,771 0001601842634 1901014709810003
2713
Indo Tuo
PESERTA
09/07/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,772 0001601842645 1901016208460001
2713
Syiana
TAMBAHAN
22/08/1946
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,773 0001601842656 1901010911550001
2716
Sinok
PESERTA
11/09/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,774 0001601842667 1901014511670002
2716
Lilis Suryani
ISTRI
11/05/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,775 0001601842678 1901015207930003
2716
Lilis Sudarti
ANAK
07/12/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,776 0001601842689 1901015308980003
2716
Harlina
ANAK
13/08/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,777 0001601842691 1901014403030004
2716
Nofia A. Riani
ANAK
03/04/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,778 0001601842702 1901015802050002
2716
Sumarni
ANAK
18/02/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,779 0001601842713 1901015704730004
2722
Nurfika
PESERTA
17/04/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,780 0001601842724 1901016704950003
2722
Fera
ANAK
27/04/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 208 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,781 0001601842735 1901015003000005
2722
Surya
ANAK
03/10/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,782 0001601842746 1901012705070005
2722
Bujang
ANAK
27/05/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,783 0001601842757 1901010205900002
2726
Ali
PESERTA
05/02/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,784 0001601842768 1901012506670001
2727
A. Bong
PESERTA
25/06/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,785 0001601842779 1901015411910001
2728
Lina nova
PESERTA
14/11/1991
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,786 0001601842781 1901012301950009
2728
Chandra Janpiter
TAMBAHAN
23/01/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,787 0001601842792 1901012407420001
2730
Zaldi Samsudin
PESERTA
24/07/1942
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,788 0001601842803 1901014702700001
2730
Sumiyati
ISTRI
02/07/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,789 0001601842814 1901011307020001
2730
Arron Junior
ANAK
13/07/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,790 0001601842825 1901016109550004
2733
Sukiati Samsudin
PESERTA
21/09/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,791 0001601842836 1901012307570002
2733
Nurdin Samsudin
TAMBAHAN
23/07/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,792 0001601842847 1901010507430001
2733
Jaldi Samsudin
TAMBAHAN
07/05/1943
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,793 0001601842858 1901012404810007
2736
Toni Harsono
PESERTA
24/04/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,794 0001601842869 1901014707820003
2736
Eti Romliyati
ISTRI
07/07/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,795 0001601842871 1901014501010001
2736
Jean Kamila
ANAK
01/05/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,796 0001601842882 1901010905070001
2736
Ataric
ANAK
05/09/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,797 0001601842893 1901010506770003
2743
Jamaludin
PESERTA
06/05/1977
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,798 0001601842904 1901014306800003
2743
Armila
ISTRI
06/03/1980
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,799 0001601842915 1901010305990001
2743
Arjun Maulana
ANAK
05/03/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,800 0001601842926 1901015310030001
2743
Anjali Oktaviani
ANAK
13/10/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,801 0001601842937 1901010802670002
2750
Syahrial
PESERTA
02/08/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,802 0001601842948 1901015301690004
2750
Alpiah
ISTRI
13/01/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,803 0001601842959 1901010708950008
2750
Muhamad Abdul Azis
ANAK
08/07/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 209 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,804 0001601842961 1901016701970004
2750
Ainul Mardhliyah
ANAK
27/01/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,805 0001601842972 1901014912990003
2750
Siti Aisyah
ANAK
09/12/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,806 0001601842983 1901010107490011
2750
Sudarman
TAMBAHAN
07/01/1949
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,807 0001601842994 1901012408580001
2756
Chairil Azwar
PESERTA
24/08/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,808 0001601843005 1901015509670001
2756
Juriati
ISTRI
15/09/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,809 0001601843016 1901011811010001
2756
Noviar Revanza
ANAK
18/11/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,810 0001601843027 1901014201350001
2759
Djami.B. Adjis
PESERTA
01/02/1935
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,811 0001601843038 1901016007680004
2759
Masnah
ANAK
20/07/1968
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,812 0001601843049 1901011306670001
2761
Bustomi
PESERTA
13/06/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,813 0001601843051 1901015509640001
2761
Nurm Ariam
ISTRI
15/09/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,814 0001601843062 1901015609630006
2763
Jin Jin
PESERTA
16/09/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,815 0001601843073 1901014907960003
2763
Julita
ANAK
07/09/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,816 0001601843084 1901010911990005
2763
Nova Ardianto
ANAK
11/09/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,817 0001601843095 1901015512370003
2763
Ten Mie Lan
TAMBAHAN
15/12/1937
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,818 0001601843106 1901015203540003
2767
Murniana
PESERTA
03/12/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,819 0001601843117 1901011408900009
2767
Agustap Sahata
ANAK
14/08/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,820 0001601843128 1901014702330001
2784
Rohina
PESERTA
02/07/1933
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,821 0001601843139 1901016903870003
2786
Kurnia
PESERTA
29/03/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,822 0001601843141 1901010402880001
2789
Yuswardi
PESERTA
02/04/1988
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,823 0001601843152 1901016612890001
2789
Sri Widihastuti
ISTRI
26/12/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,824 0001601843163 1901011210060001
2789
Haikal Anggra Ramadh
ANAK
12/11/2006
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,825 0001601843174 1901014307110003
2789
Silva Anggreny
ANAK
07/03/2011
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,826 0001601843185 1901011212640005
2793
Buhari Muslim
PESERTA
12/12/1984
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 210 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,827 0001601843196 1901015405720003
2793
Siti Mulia
ISTRI
14/05/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,828 0001601843207 1901015104040007
2793
Ernawati
ANAK
04/11/2004
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,829 0001601843218 1901013008800004
2793
Andi Mulyadi
TAMBAHAN
30/08/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,830 0001601843229 1901010608920002
2793
Andi Lukman
TAMBAHAN
08/06/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,831 0001601843231 1901016708940003
2793
Andi Melda
TAMBAHAN
27/06/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,832 0001601843242 1901016810000003
2793
Andi Rika Pardaliana
TAMBAHAN
28/10/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,833 0001601843253 1901014710080003
2793
Jihan Aulia
TAMBAHAN
10/07/2008
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,834 0001601843264 1901012009760011
2801
Amir
PESERTA
20/09/1976
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,835 0001601843275 1901011111890001
2805
Arfendi Jaya
PESERTA
11/11/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,836 0001601843286 1901013008450001
2808
Bagak
PESERTA
30/08/1945
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,837 0001601843297 1901014204650002
2808
Iriyanti
ISTRI
04/02/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,838 0001601843308 1901012804960002
2808
Akbar Ismail
ANAK
28/04/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,839 0001601843319 1901012807600012
2811
Sabarudin
PESERTA
28/07/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,840 0001601843321 1901015609870006
2811
Midah
ISTRI
16/09/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,841 0001601843332 1901016506080002
2811
Yunita
ANAK
25/06/2008
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,842 0001601843343 1901011009100001
2811
Fahri Febriansyah
ANAK
09/10/2010
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,843 0001601843354 1901010904600007
2815
Basri
PESERTA
04/09/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,844 0001601843365 1901016512720007
2815
Darmawati
ISTRI
25/12/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,845 0001601843376 1901016502980001
2815
Anita
ANAK
25/02/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,846 0001601843387 1901011708030008
2815
Baharudin
ANAK
17/06/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,847 0001601843398 1901015511740003
2819
Helmiah
PESERTA
15/11/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,848 0001601843409 1901011507950004
2819
Rahmat Hidayat
ANAK
15/07/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,849 0001601843411 1901015104010002
2819
Suci Wahyuni
ANAK
04/11/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 211 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,850 0001601843422 1901010505420001
2826
Ismail Djemain
PESERTA
05/05/1942
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,851 0001601843433 1901015204550002
2826
Solnah
ISTRI
04/12/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,852 0001601843444 1901011204830001
2826
Indra Gunawan
ANAK
04/12/1983
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,853 0001601843455 1901015406820006
2830
Amsih
PESERTA
14/06/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,854 0001601843466 1901015805840010
2831
Susilawati
PESERTA
18/05/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,855 0001601843477 1901012710030006
2831
Angga Saputra
ANAK
27/10/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,856 0001601843488 1901015810070006
2831
Anggi Safitri Oktavian
ANAK
18/10/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,857 0001601843499 1901015102570003
2834
Muriani
PESERTA
02/11/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,858 0001601843501 1901013101910004
2900
Hana Chistiana
PESERTA
24/09/2012
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,859 0001601843512 1901012911920001
2906
Susanto
PESERTA
12/12/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,860 0001601843523 1904012710680002
2919
Jumiah
PESERTA
06/03/1952
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,861 0001601843534 1901016507520004
2923
Jennek
PESERTA
25/07/1952
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,862 0001601843545 1901011503740004
2923
M.Ali Sadikin
ANAK
15/03/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,863 0001601843556 1901012706770005
2923
Syamsul
ANAK
27/06/1977
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,864 0001601843567 1901011104400001
2927
Tugiatmo
PESERTA
04/11/1946
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,865 0001601843578 1901014200010001
2927
Kartini
ISTRI
05/02/1934
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,866 0001601843589 1901012100230008
2927
Sumardi
ANAK
21/09/1976
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,867 0001601843591 1901014206400001
2930
Hatijah
PESERTA
06/02/1940
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,868 0001601843602 1901012805660001
2930
Haryanto
ANAK
28/05/1986
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,869 0001601843613 1901012304710001
2930
Gunawan
ANAK
23/04/1971
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,870 0001601843624 1901014703890002
2934
Rita
PESERTA
03/07/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,871 0001601843635 1901010501500005
2935
Anwar Hasan
PESERTA
01/05/1950
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,872 0001601843646 1901014902590003
2935
Aliun
ISTRI
02/09/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 212 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,873 0001601843657 1901010504820006
2938
Samsudin
PESERTA
04/05/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,874 0001601843668 1901014910810002
2938
Rodiah
ISTRI
10/09/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,875 0001601843679 1901010808120001
2938
Muhamad Idal Fsr
ANAK
08/08/2012
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,876 0001601843681 1901016312010003
2938
Putri Phila Delpia
TAMBAHAN
23/12/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,877 0001601843692 1901015410060001
2938
Mucika Ratu Oktavia
TAMBAHAN
14/10/2006
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,878 0001601843703 1901011511790004
2943
Ahmadi
PESERTA
15/11/1979
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,879 0001601843714 1901010209850006
2943
Erlan Pratna
TAMBAHAN
09/02/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,880 0001601843725 1901015202950004
2947
Mariana Febriyanti
PESERTA
02/12/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,881 0001601843736 1901015607180001
2947
Imah Lusia
TAMBAHAN
16/07/1918
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,882 0001601843771 1901016704570001
2953
Rurina Sari.A.Gani
PESERTA
27/04/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,883 0001601843782 1901010106700002
2956
Khin Hoa
PESERTA
06/01/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,884 0001601843793 1901012003650001
2957
Yanto
PESERTA
20/03/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,885 0001601843804 1901014505850001
2957
Weni
ISTRI
05/05/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,886 0001601843815 1901012707040001
2957
Toni
ANAK
27/07/2004
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,887 0001601843826 1901010501570002
2960
Liauw Kap Soei
PESERTA
01/05/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,888 0001601843837 1901014501540003
2960
Erma
ISTRI
01/05/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,889 0001601843848 1901010906910001
2960
Rendi Junardi
ANAK
06/09/1991
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,890 0001601843859 1901016008360001
2963
Ng Muk Lan
PESERTA
20/08/1936
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,891 0001601843861 1901015404550083
2964
Siti Aisyah
PESERTA
04/04/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,892 0001601843872 1901014808330001
2965
Loe Mie Mie
PESERTA
06/08/1933
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,893 0001601843883 1901016312730002
2965
Cau Yu
ANAK
23/12/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,894 0001601843894 1901015507600003
2967
Sasi
PESERTA
15/07/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,895 0001601843905 1901011302610001
2969
Mardaris Tamsa
PESERTA
13/02/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 213 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,896 0001601843916 1901010107650037
2970
Ripin
PESERTA
07/01/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,897 0001601843927 1901014510350003
2973
Tjen Kin Mie
PESERTA
10/05/1935
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,898 0001601843938 1901012103580003
2973
Tjhen Djun San
ANAK
21/03/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,899 0001601843949 1901011903730003
2973
Tjhen Djun Kho
ANAK
19/03/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,900 0001601843951 1901015103410001
2976
Margareta Azpan
PESERTA
03/11/1941
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,901 0001601843962 1901014609540004
2976
Sabina Azpan
TAMBAHAN
09/06/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,902 0001601843973 1901016410630007
2976
Diana Azpan
TAMBAHAN
24/10/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,903 0001601843984 1901015612670003
2979
Tjioe Ngiam Fa
PESERTA
16/12/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,904 0001601843995 1901014402910001
2983
Yulia Chaelwin
PESERTA
02/04/1991
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,905 0001601844006 1901017107604002
2984
Juminten
PESERTA
03/10/1944
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,906 0001601844017 1901011011780001
2984
Heryanto
ANAK
11/10/1976
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,907 0001601844028 1901015504330001
2986
Ng A. Djam
PESERTA
15/04/1933
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,908 0001601844039 1901011312610003
2986
Fan Khiong
ANAK
13/12/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,909 0001601844041 1901010510640004
2986
Fan Joeng
ANAK
10/05/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,910 0001601844052 1901010306670006
2986
Fan Hen
ANAK
06/03/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,911 0001601844063 1901015110710002
2986
Fui Sung
ANAK
10/11/1971
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,912 0001601844074 1901017009510001
2991
Ana Karyosetono
PESERTA
30/09/1951
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,913 0001601844085 1901013103760001
2991
Andi Irfansyah
ANAK
31/03/1976
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,914 0001601844096 1901015107680003
2994
Kusmiati
PESERTA
07/11/1968
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,915 0001601844107 1901012101940004
2994
Buckie Januar A.B
ANAK
21/01/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,916 0001601844118 1901015611000002
2994
Novela Cantika B
ANAK
16/11/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,917 0001601844129 1901014608740005
2997
Suhartini
PESERTA
08/06/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,918 0001601844131 1901016609990002
2997
Vira Disty Saputri
ANAK
26/09/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 214 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,919 0001601844142 1901016112050005
2997
Tuti Heriyati
ANAK
21/12/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,920 0001601844153 1901010107530002
3000
Bedu Renang
PESERTA
07/01/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,921 0001601844164 1901015201470002
3000
Milang
ISTRI
01/12/1947
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,922 0001601844175 1901015601850003
3000
Ratna Dewi
ANAK
16/01/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,923 0001601844186 1901011211870001
3000
Edi rahmat
ANAK
12/11/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,924 0001601844197 1901010208510005
3004
Ahmad Rifa'i
PESERTA
08/02/1951
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,925 0001601844208 1901017112540008
3004
Rabima
ISTRI
31/12/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,926 0001601844219 1901010103900005
3004
Jumari
ANAK
03/01/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,927 0001601844221 1901014107620024
3010
Sarpah
PESERTA
07/01/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,928 0001601844232 1901010810500003
3011
A. Rahman
PESERTA
10/08/1950
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,929 0001601844243 1901015204600002
3011
Mardiana
ISTRI
04/12/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,930 0001601844254 1901012907000005
3011
Roviqo Zain Illahi
TAMBAHAN
29/07/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,931 0001601844265 1901011010050008
3011
Ramadhan Aziz Hidayat
TAMBAHAN
10/10/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,932 0001601844276 1901010505380001
3015
Muchsin
PESERTA
05/05/1938
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,933 0001601844287 1901012008720001
3015
Riduanto
ANAK
20/08/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,934 0001601844298 1901014203600003
3017
Elis Santiani
PESERTA
03/02/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,935 0001601844309 1901016409480003
3019
Zubaidah
PESERTA
24/09/1948
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,936 0001601844311 1901014512660003
3019
Misdawani
ANAK
12/05/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,937 0001601844322 1901016501680004
3023
Sri Maja Robiani
PESERTA
25/01/1968
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,938 0001601844333 1901010411810004
3023
Sri maja Noviyo
TAMBAHAN
11/04/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,939 0001601844344 1901010302860001
3023
Sri Maja Friansyah
TAMBAHAN
02/03/1986
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,940 0001601844355 1901011708920006
3023
Sri Agustiawan
TAMBAHAN
17/08/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,941 0001601844366 1901010107170001
3028
Djapar Radjab
PESERTA
07/01/1917
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 215 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,942 0001601844377 1901014107190001
3028
Nurkia
ISTRI
07/01/1919
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,943 0001601844388 1901015109530001
3028
Sa ilanjati Kuntjung
ANAK
09/11/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,944 0001601844399 1901010103420001
3031
Juhaili
PESERTA
03/01/1942
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,945 0001601844401 1901015901430002
3031
Bun A Loi
ISTRI
01/09/1943
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,946 0001601844412 1901014806760001
3031
Lilis
ANAK
06/08/1976
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,947 0001601844423 1901016512690003
3034
Sumiati
PESERTA
25/12/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,948 0001601844434 1901012508860002
3034
Ronaldo
ANAK
25/08/1986
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,949 0001601844445 1901015309930005
3034
Popy Evalianti
ANAK
13/09/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,950 0001601844456 1901014101400012
3034
Rohijah
TAMBAHAN
01/01/1940
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,951 0001601844467 1901010301570001
3038
Muhamad Rizal
PESERTA
01/03/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,952 0001601844478 1901014205580001
3038
Maryani
ISTRI
05/02/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,953 0001601844489 1901010303850001
3038
M.Adi
ANAK
03/03/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,954 0001601844491 1901011307950001
3038
Rulli Kurniawan
ANAK
13/07/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,955 0001601844502 1901010502830005
3042
Kasmiadi
PESERTA
02/05/1983
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,956 0001601844513 1901016803790005
3042
Ervila
ISTRI
28/03/1979
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,957 0001601844524 1901016005100003
3042
Meiza Wahidza Putriadi
ANAK
20/05/2010
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,958 0001601844535 1901012003380001
3045
Aan
PESERTA
20/08/1938
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,959 0001601844546 1901016610870003
3047
Hendi
PESERTA
26/10/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,960 0001601844557 1901012005900002
3047
Aryanto
ANAK
20/05/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,961 0001601844568 1901012503930002
3047
Sapta Martono
ANAK
25/03/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,962 0001601844579 1901011006520001
3058
Haris Fadillah
PESERTA
10/06/1952
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,963 0001601844581 1901011404940002
3058
Ingga Irwanda
ANAK
14/04/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,964 0001601844592 1901011206950003
3058
Putra Ansela
ANAK
12/06/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 216 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,965 0001601844603 1901014103980003
3058
Diyang
ANAK
01/03/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,966 0001601844614 1901014101040001
3058
Tiyas Indriani
ANAK
01/01/2004
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,967 0001601844625 1901011002490001
3064
Hamsah
PESERTA
10/02/1949
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,968 0001601844636 1901015905570001
3064
Suri'ah
ISTRI
19/05/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,969 0001601844647 1901013007840001
3064
Sumitro
ANAK
30/07/1984
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,970 0001601844658 1901016401870002
3064
Sari Juwita
ANAK
24/01/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,971 0001601844669 1901010205940001
3064
Megi Saputra
ANAK
02/05/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,972 0001601844671 1901014205940001
3064
Meti Saputri
ANAK
02/05/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,973 0001601844682 1901011003440001
3070
M. Nur MA'ie
PESERTA
10/03/1944
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,974 0001601844693 1901015404440001
3070
Zanariah
ISTRI
14/04/1944
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,975 0001601844704 1901012407760001
3070
Ansori
ANAK
24/07/1976
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,976 0001601844715 1901010512570001
3073
Sarosa Arba'a
PESERTA
05/12/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,977 0001601844726 1901015407680002
3073
Wari
ISTRI
14/07/1968
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,978 0001601844737 1901010306880002
3073
Putra Yansah
ANAK
03/06/1988
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,979 0001601844748 1901010306890006
3073
Darma Yansa
ANAK
03/06/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,980 0001601844759 1901015004560003
3077
Siti Hawa
PESERTA
10/04/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,981 0001601844761 1901010303810008
3077
Jupri
ANAK
03/03/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,982 0001601844772 1901015104440002
3082
Munara
PESERTA
11/04/1944
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,983 0001601844783 1901010207590001
3083
Ibrahim
PESERTA
02/07/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,984 0001601844794 1901014103730005
3083
Mega
ISTRI
01/03/1973
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,985 0001601844805 1901014407500001
3083
Mustini
TAMBAHAN
04/07/1950
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,986 0001601844816 1901010107520014
3088
Maming
PESERTA
01/07/1952
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,987 0001601844827 1901012107750001
3088
Napisah
ISTRI
01/07/1978
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 217 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
4,988 0001601844838 1901011707940008
3088
Firmansyah
ANAK
17/07/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,989 0001601844849 1901015001950002
3088
Hanima
ANAK
10/01/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,990 0001601844851 1901015511990008
3088
Suhartati
ANAK
15/11/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,991 0001601844862 1901010404050007
3088
Ferdiyansah
ANAK
04/04/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,992 0001601844873 1901015107640001
3102
Sarifah
PESERTA
11/07/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,993 0001601844884 1901011010820021
3102
Sengeng
ANAK
10/10/1982
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,994 0001601844895 1901011010530012
3104
Baba
PESERTA
10/10/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,995 0001601844906 1901014904550002
3104
Cabra
ISTRI
09/04/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,996 0001601844917 1901011212800012
3104
Samsul Bahri
ANAK
12/12/1980
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,997 0001601844928 1901016406860005
3104
Aminah
ANAK
24/12/1986
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,998 0001601844939 1901010802980004
3104
Fitrya
ANAK
08/02/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
4,999 0001601844941 1901010807040007
3104
Muhamad Ikhsan
ANAK
08/07/2004
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,000 0001601844952 1901014111770003
3110
Linda Royana
PESERTA
01/11/1977
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,001 0001601844963 1901011808970004
3110
Hariyanto
ANAK
18/08/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,002 0001601844974 1901016511030004
3110
Puspitasari
ANAK
25/11/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,003 0001601844985 1901015304040002
3110
Mayasari
ANAK
13/04/2004
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,004 0001601844996 1901010712590003
3114
Abdul Ajis
PESERTA
07/12/1959
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,005 0001601845007 1901015008630003
3114
Rohana
ISTRI
10/08/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,006 0001601845018 1901010307900004
3114
Suryandi
ANAK
03/07/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,007 0001601845029 1901012611910006
3114
Saparudin
ANAK
26/11/1991
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,008 0001601845031 1901016809930002
3114
Nirmala Anjar Sari
ANAK
28/09/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,009 0001601845042 1901014611960003
3114
Sahara
ANAK
06/11/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,010 0001601845053 1901011107010007
3114
Alamsyah
ANAK
11/07/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 218 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,011 0001601845064 1901012908030006
3114
Jumadi
ANAK
29/08/2003
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,012 0001601845075 1901014307840006
3124
Ernawati
PESERTA
03/07/1984
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,013 0001601845086 1901012308780005
3124
Sutikno
TAMBAHAN
23/08/1978
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,014 0001601845097 1901011708540006
3126
Nurdin
PESERTA
17/08/1954
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,015 0001601845108 1901016105580002
3126
Kartini
ISTRI
21/05/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,016 0001601845119 1901011405600002
3128
Kadir
PESERTA
14/05/1960
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,017 0001601845121 1901014607720003
3128
Marwa
ISTRI
06/07/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,018 0001601845132 1901012803930004
3128
Supardi
ANAK
28/03/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,019 0001601845143 1901014101950004
3128
Fitriyani
ANAK
01/01/1995
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,020 0001601845154 1901017010000005
3128
Anjela
ANAK
30/10/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,021 0001601845165 1901011302050003
3128
Ferdi
ANAK
13/02/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,022 0001601845176 1901010307110003
3128
Fery Rahman
ANAK
03/07/2011
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,023 0001601845187 1901015004470001
3128
Buah
TAMBAHAN
10/04/1947
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,024 0001601845198 1901015511200001
3139
Rinten
PESERTA
15/11/1920
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,025 0001601845209 1901012109400001
3139
Hadise
TAMBAHAN
21/09/1940
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,026 0001601845211 1901016302500001
3143
Guna
PESERTA
23/02/1950
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,027 0001601845222 1901014303900008
3143
Irmawati
ANAK
03/03/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,028 0001601845233 1901010503530002
3145
NUR ALAMSYAH
PESERTA
05/03/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,029 0001601845244 1901012905370001
3146
LIE NEN SOEN
PESERTA
29/05/1937
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,030 0001601845255 1901011503490002
3149
YUNO LASIN
PESERTA
15/03/1949
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,031 0001601845266 1901016306720001
3151
DEWI UTARI
PESERTA
23/06/1972
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,032 0001601845277 1901010906560001
3152
A. FAHMI
PESERTA
09/06/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,033 0001601845288 1901016901750001
3153
EVI NOVITA DAUD

KURNIAWAN
PESERTA
29/01/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 219 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,034 0001601845299 1901010605810005
3155
LIM TJHEN FUI
PESERTA
06/05/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,035 0001601845301 1901016806560005
3156
LIONG LI YOEN
PESERTA
28/06/1956
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,036 0001601845312 1901011405850002
3158
BONG THIAN SE
PESERTA
14/05/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,037 0001601845323 1901014107670027
3159
WA ODE HAFIAH
PESERTA
01/07/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,038 0001601845334 1901011201920005
3159
YOCKI SYAHPUTRA ODE
ANAK
12/01/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,039 0001601845345 1901014509380001
3162
MANIAH
PESERTA
05/08/1938
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,040 0001601845356 1901015208570004
3165
SOLLIAH
PESERTA
12/08/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,041 0001601845367 1901010707770011
3165
SUDIRMAN
ANAK
07/07/1977
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,042 0001601845378 1901010107860031
3165
HENDRI
ANAK
01/07/1986
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,043 0001601845389 1901011403460001
3168
IMRAN BIN LAODE MUSA
PESERTA
14/03/1946
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,044 0001601845391 1901010408020004
3168
LAODE MUHAMAD KASIM
ANAK
04/08/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,045 0001601845402 1901014803670001
3170
YANTI
PESERTA
08/03/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,046 0001601845413 1901010509920002
3170
MAMAT SANJAYA PUTRA
ANAK
05/09/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,047 0001601845424 1901015011960003
3170
SITTI AISA
ANAK
10/11/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,048 0001601845435 1901012802050002
3170
VINO FEBRIYAN ANANDA
ANAK
28/02/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,049 0001601845446 1901014101050001
3174
RAWE
PESERTA
01/01/1905
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,050 0001601845457 1901010303480003
3175
SANI BIN ITJIM
PESERTA
03/03/1948
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,051 0001601845468 1901015006580002
3175
AMINAH
ISTRI
10/06/1958
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,052 0001601845479 1901014703610002
3177
DAMIANA
PESERTA
07/03/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,053 0001601845481 1901014608890004
3177
HOMISAH
ANAK
06/08/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,054 0001601845492 1901015304660001
3179
NUNI
PESERTA
13/04/1966
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,055 0001601845503 1901012608830002
3179
TOHAr
ANAK
26/08/1983
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,056 0001601845514 1901010107470011
3181
ISAH
PESERTA
07/01/1947
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 220 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,057 0001601845525 1901014208570004
3182
AMINAH
PESERTA
08/02/1957
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,058 0001601845536 1901010506890003
3182
MIZAR RIADI
ANAK
06/05/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,059 0001601845547 1901010510940003
3182
DEDI SAPUTRA
ANAK
10/05/1994
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,060 0001601845558 1901014706490002
3185
ROHANI
PESERTA
06/07/1949
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,061 0001601845569 1901010506830008
3185
AMRAN
ANAK
06/05/1983
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,062 0001601845571 1901011010860007
3185
AMRIN
ANAK
10/10/1986
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,063 0001601845582 1901014907690006
3188
EMI YULPANI
PESERTA
07/09/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,064 0001601845593 1901010606970004
3188
SUHEDRA
ANAK
06/06/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,065 0001601845604 1901010802330001
3190
LAMPISAH
PESERTA
02/08/1933
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,066 0001601845615 1901016308530002
3190
ANYUN
ISTRI
23/08/1953
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,067 0001601845626 1901015705870004
3190
ZAKIA
ANAK
17/05/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,068 0001601845637 1901011210640004
3193
LAODE RAHINU
PESERTA
12/10/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,069 0001601845648 1901015703810001
3193
WAODE NURANI
ANAK
17/03/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,070 0001601845659 1901017112480007
3195
MAIMUNAH
PESERTA
31/12/1948
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,071 0001601845661 1901012202870001
3195
NAZIR
ANAK
22/02/1987
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,072 0001601845672 1901015004460007
3197
RAIMA
PESERTA
10/04/1946
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,073 0001601845683 1901012708680007
3197
LANAE
TAMBAHAN
27/08/1968
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,074 0001601845694 1901011208520002
3199
LAODE SAMIUN
PESERTA
12/08/1952
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,075 0001601845705 1901014107630031
3199
SUMARTINI
ISTRI
01/07/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,076 0001601845716 1901010107890019
3199
HERMANSYAH
ANAK
07/01/1989
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,077 0001601845727 1901010107910025
3199
TRISNO
ANAK
07/01/1991
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,078 0001601845738 1901011506770012
3203
DAUD
PESERTA
15/06/1977
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,079 0001601845749 1901012108810001
3203
LISA
TAMBAHAN
21/08/1981
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 221 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,080 0001601845751 1901010101450003
3205
KAPI
PESERTA
16/01/1951
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,081 0001601845762 1901011707600001
3205
TAJUDIN
TAMBAHAN
10/07/1961
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,082 0001601845773 1901014503640006
3205
NURLINA
TAMBAHAN
05/03/1964
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,083 0001601845784 1901011509440001
3208
LA ROLI
PESERTA
15/09/1944
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,084 0001601845795 1901011203630001
3209
RUSMAN
PESERTA
12/03/1963
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,085 0001601845806 1901016204650001
3209
WA ODE HADIJA
ISTRI
22/04/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,086 0001601845817 1901012312910003
3209
HERMANTO
ANAK
23/12/1991
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,087 0001601845828 1901011210670001
3212
ABDULLAH
PESERTA
12/10/1967
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,088 0001601845839 1901014603690002
3212
HAMIDAH
ISTRI
03/06/1969
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,089 0001601845841 1901011501920002
3212
ANGGA SAPUTRA
ANAK
15/01/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,090 0001601845852 1901012203970001
3212
JOHAN
ANAK
22/03/1997
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,091 0001601845863 1901012606990004
3212
RISKI RIZAL
ANAK
26/06/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,092 0001601845874 1901015005480003
3212
SAUDAH
TAMBAHAN
10/05/1948
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,093 0001601845885 1901014509700002
3218
SINA
PESERTA
09/05/1970
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,094 0001601845896 1901010210920006
3218
RAFIAN
ANAK
10/02/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,095 0001601845907 1901010210920007
3218
RAFIQI
ANAK
02/10/1992
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,096 0001601845918 1901011011960002
3218
SUPIANSYAH
ANAK
10/11/1996
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,097 0001601845929 1901010201980002
3218
RIVAL ODE
ANAK
01/02/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,098 0001601845931 1901012904050002
3218
HABIL HUDHA
ANAK
29/04/2005
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,099 0001601845942 1901010107490017
3224
ROSNAH
PESERTA
07/01/1949
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,100 0001601845953 1901010107800047
3224
KOKO
ANAK
07/01/1980
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,101 0001601845964 1901011708880016
3224
AGUSTINO
ANAK
17/08/1988
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,102 0001601845975 1901016310740005
3227
WA ODE PATIMAH
PESERTA
23/10/1974
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 222 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,103 0001601845986 1901016004980001
3227
WA ODE INDRI HAIRANI
ANAK
20/04/1998
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,104 0001601845997 1901017101000003
3227
WA ODE PUJI ASTUTI
ANAK
31/01/2000
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,105 0001601846008 1901014107300005
3227
WA ODE ICA
TAMBAHAN
07/01/1930
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,106 0001601846019 1901013006850004
3231
SOPIAN
PESERTA
30/06/1985
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,107 0001601846021 1901015206040002
3231
RINTI SULASTRI
TAMBAHAN
12/06/2004
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,108 0001601846032 1901015812550004
3233
CIK AYU
PESERTA
18/12/1955
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,109 0001601846043 1901012303840009
3233
IRWANSYAH
ANAK
23/03/1984
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,110 0001601846054 1901015211900006
3233
SUTIANA
ANAK
12/11/1990
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,111 0001601846065 1901015309620005
3236
WA ODE SAHIRA
PESERTA
13/09/1962
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,112 0001601846087 1901014612930004
3236
ARNI WATI
ANAK
12/06/1993
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,113 0001601846098 3204290107650028
3239
E. SUTISNA
PESERTA
07/01/1965
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,114 0001601846109 3204294108750017
3239
TATI ROSMAWATI
ISTRI
08/01/1975
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,115 0001601846111 3204292107990011
3239
TAUPIQ JAMALUDIN
ANAK
21/07/1999
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,116 0001601846122 3204291508010011
3239
AGI CANDA PERMANA
ANAK
15/08/2001
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,117 0001601846133 3204294311020003
3239
IIS ISMAYANTI
ANAK
11/03/2002
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,118 0001601846144 3204291511040004
3239
ISEP ABDUL ROJAK
ANAK
15/11/2004
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,119 0001601846155 3204291308060009
3239
ALIT BAGUS SALIM
ANAK
13/08/2006
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,120 0001601846166 1901012808770004
3246
ISKANDARA
PESERTA
28/08/1977
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,121 0001601846177 1901014304800002
3246
MISNATUN
ISTRI
04/03/1980
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,122 0001601846188 1901014206070001
3246
ASTIKA SARI
ANAK
06/02/2007
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,123 0001601846199 1901016401140005
3246
JASKIA JELITA
ANAK
24/01/2014
SUNGAILIAT
01/01/2015
AKTIF
19,225
30/12/2014
5,124 0001601850622 1901080107480006
4559
Arsad bin asir
PESERTA
01/07/1948
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,125 0001601850633 1901085311500002
4559
Seri'ah
ISTRI
13/11/1950
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 223 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,126 0001601862772 1901081112790002
4559
Junaidi
ANAK
11/12/1979
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,127 0001601850655 1901080808410001
4562
Ishak said
PESERTA
01/08/1949
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,128 0001601862783 1901085009520001
4562
Rosnah
ISTRI
01/07/1954
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,129 0001601850677 1901081101780003
4564
Mustari
PESERTA
11/07/1978
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,130 0001601862794 1901084107800032
4564
Sumiati
ISTRI
01/07/1978
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,131 0001601850699 1901082203000003
4564
Ahmad ardiansyah
ANAK
22/03/2000
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,132 0001601862805 1901080601120001
4564
M.hanafi
ANAK
06/12/2012
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,133 0001601850712 1901081802730001
4568
Lasita
PESERTA
18/02/1973
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,134 0001601850734 1901082704970001
4568
Andra gunawan
ANAK
27/04/1997
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,135 0001601862816 1901081606950004
4568
Kari
ANAK
16/06/1995
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,136 0001601862827 1901084305940002
4568
Meilani
TAMBAHAN
03/05/1994
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,137 0001601850756 1901084401700001
4572
Maryam
PESERTA
04/01/1970
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,138 0001601850767 1901085111310001
4573
Almi
PESERTA
11/11/1930
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,139 0001601850778 1901085007560001
4574
Hijirma
PESERTA
10/07/1956
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,140 0001601850802 1901081111070003
4574
Surya
ANAK
02/08/1987
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,141 0001601862838 1901085002880002
4574
Catra
ANAK
10/02/1988
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,142 0001601862849 1901084105940002
4574
Rapti sumantri
ANAK
01/05/1994
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,143 0001601850813 1901084103600002
4578
Sauda
PESERTA
01/03/1960
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,144 0001601862851 1901080204800001
4578
Tarmizi
ANAK
02/04/1980
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,145 0001601850835 1901084506420001
4580
Jami'ah
PESERTA
05/06/1942
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,146 0001601862862 1901081210780001
4580
Busril
ANAK
12/10/1978
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,147 0001601850857 1901081708740002
4582
Adon
PESERTA
17/08/1974
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,148 0001601862873 1901085709790001
4582
Nuraini
ISTRI
17/09/1979
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 224 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,149 0001601850879 1901080303890001
4584
Mujarab
PESERTA
03/03/1989
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,150 0001601862884 1901087006920001
4584
Devi Sari
ISTRI
30/06/1992
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,151 0001601862895 1901085803110001
4584
Dhiva azhipa
ANAK
18/03/2011
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,152 0001601850903 1901084107630021
4587
Hanimah
PESERTA
07/12/1957
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,153 0001601850925 1901080808990002
4587
Kemal
ANAK
08/08/1999
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,154 0001601862906 1901081811950002
4587
aswandi
ANAK
01/07/1988
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,155 0001601850936 1901086105730002
4590
Juma'ah
PESERTA
21/05/1973
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,156 0001601850958 1901082705050002
4590
Eko wiranata
ANAK
27/05/2005
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,157 0001601850971 1901084801090001
4590
Asila naila alipah
ANAK
08/01/2009
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,158 0001601862917 1901081112970001
4590
Amat
ANAK
11/12/1997
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,159 0001601862928 1901082705050003
4590
Eki wiranata
ANAK
27/05/2005
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,160 0001601850982 1901081906790003
4595
asban
PESERTA
19/06/1979
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,161 0001601862939 1901085903860001
4595
atik
ISTRI
19/03/1986
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,162 0001601851004 1901086203100001
4595
assyifa vivian
ANAK
22/03/2010
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,163 0001601851015 1901081012660001
4598
bustamal
PESERTA
10/12/1966
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,164 0001601862941 1901085703680001
4598
haroma
ISTRI
17/03/1968
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,165 0001601851037 1901086904910003
4598
vivi purnama
ANAK
29/04/1991
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,166 0001601862952 1901080410980003
4598
robiyandi
ANAK
04/10/1998
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,167 0001601851059 1901085003540002
4602
armili
PESERTA
10/03/1954
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,168 0001601851094 1901085510930002
4602
yuyun yana
ANAK
15/10/1993
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,169 0001601862963 1901082209830003
4602
julianto
ANAK
22/09/1983
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,170 0001601862974 1901080306910001
4602
ukod
ANAK
03/06/1991
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,171 0001601862985 1901080303980001
4602
ilham
ANAK
03/03/1998
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 225 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,172 0001601851116 1901080107620016
4608
Yazid
PESERTA
01/08/1962
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,173 0001601851127 1901085107740002
4608
hasunah
ISTRI
11/07/1974
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,174 0001601851138 1901080110810002
4610
herman
PESERTA
01/10/1989
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,175 0001601862996 1901087011920002
4610
siti marbi
ISTRI
31/07/1992
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,176 0001601851151 1901062504840004
4612
Rohmat
PESERTA
25/04/1984
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,177 0001601863007 1901084811830001
4612
Melina
ISTRI
21/10/1982
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,178 0001601851173 1901085006090001
4612
Dinda Lestari
ANAK
10/06/2009
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,179 0001601851217 1901080902790002
4623
MANSOR
PESERTA
09/02/1979
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,180 0001601851228 1901084707840001
4623
NELI MARLINA
ISTRI
07/07/1984
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,181 0001601851241 1901082911080001
4623
MUHAMAD NAJA SAPUTRA
ANAK
29/11/2008
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,182 0001601863097 1901082304040001
4623
MUJIBURRAHMAN
ANAK
23/04/2004
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,183 0001601863108 1901080110120001
4623
MUHAMAD ADIB MUSTOFA
ANAK
01/10/2012
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,184 0001601851263 1901084107330006
4628
ROMLAH
PESERTA
01/07/1933
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,185 0001601863119 1901084107620001
4628
ROMIDAH
ANAK
01/07/1963
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,186 0001601863121 1901080707740002
4628
SUHIRMAN
ANAK
07/07/1974
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,187 0001601863132 1901080810880003
4628
FREDY
ANAK
08/10/1988
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,188 0001601863143 1901084107860014
4628
SOLEHA
ANAK
01/07/1986
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,189 0001601851318 1901080105730002
4633
FITRI
PESERTA
01/05/1973
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,190 0001601863154 1901086610780001
4633
FITRI
ISTRI
26/10/1978
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,191 0001601851331 1901086809000001
4633
NABILA AMALIA
ANAK
28/09/2000
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,192 0001601863165 1901085110020002
4633
NADIA AULIA
ANAK
11/10/2002
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,193 0001601863176 1901085107080003
4633
NAYLA
ANAK
11/07/2008
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,194 0001601851364 1901082606600001
4638
SUKIRMAN
PESERTA
26/06/1960
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 226 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,195 0001601863187 1901085904730001
4638
ROSIAH
ISTRI
19/04/1973
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,196 0001601851386 1901080508940002
4638
PAISAL
ANAK
05/08/1994
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,197 0001601851397 1901086808000001
4638
SINTA LESTARI
ANAK
10/09/2000
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,198 0001601851408 1901080603770001
4642
HERMAN
PESERTA
06/03/1977
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,199 0001601851419 1901084810820002
4642
SITI ZAHARA
ISTRI
08/10/1982
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,200 0001601851421 1901087008040002
4642
HERZA SAPUTRI
ANAK
30/08/2004
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,201 0001601851432 1901081304090001
4642
HERZI SAPUTRA
ANAK
13/04/2009
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,202 0001601851443 1901080410700001
4646
SAKBAN
PESERTA
04/10/1970
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,203 0001601851454 1901085111790002
4646
NURMILA
ISTRI
11/11/1979
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,204 0001601851465 1901084805000002
4646
OKTA DIASTARI
ANAK
08/05/2000
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,205 0001601851476 1901080801010001
4646
AUFA HAKMIY
ANAK
08/01/2001
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,206 0001601851487 1901080911720001
4650
SAMSUDIN
PESERTA
09/11/1972
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,207 0001601851498 1901084105770002
4650
SITI AISAH
ISTRI
01/05/1977
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,208 0001601851509 1901080701980001
4650
ARBAIN
ANAK
07/01/1998
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,209 0001601851511 1901081808020002
4650
ZAIRI MARIO SANDI
ANAK
18/08/2001
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,210 0001601851522 1901081208800002
4654
NURDIN
PESERTA
12/08/1980
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,211 0001601851533 1901086006940002
4654
SITI ROKAYAH
ISTRI
20/06/1994
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,212 0001601851544 1901084411120001
4654
FAATIMATUZZAHRO
ANAK
04/11/2012
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,213 0001601851555 1901081605800001
4657
ISDAN
PESERTA
16/05/1980
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,214 0001601851566 1901085003840001
4657
NILAWATI
ANAK
10/03/1984
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,215 0001601851577 1901081510010002
4657
OKY SYAHDANI
ANAK
15/10/2001
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,216 0001601851588 1901081101080002
4657
RADEN FATHIRIYAN
ANAK
11/01/2001
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,217 0001601851599 1901086407110001
4657
ZALIFA AULIA
ANAK
24/07/2011
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 227 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,218 0001601851601 1901080507700005
4662
JUMADI
PESERTA
05/07/1970
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,219 0001601851612 1901085003730002
4662
MARIAH
ISTRI
10/03/1973
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,220 0001601851623 1901082412930001
4662
MULYADI MALANI
ANAK
24/12/1993
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,221 0001601851634 1901081204010001
4662
MALDANI
ANAK
12/04/2001
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,222 0001601851645 1901081303830002
4666
ARIS PRIBADI
PESERTA
13/03/1983
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,223 0001601851656 1901085807890002
4666
SRI PURNAMA SARI
ISTRI
18/07/1989
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,224 0001601851667 1901081605120001
4666
MUHAMMAD ARYA
ANAK
16/05/2012
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,225 0001601851678 1901081010810001
4669
AMRAN
PESERTA
10/10/1981
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,226 0001601851689 1901085201820001
4669
MISMINAH
ISTRI
12/01/1982
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,227 0001601851691 1901082510040002
4669
MUHAMAD HAMDIL KHOWI
ANAK
25/10/2004
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,228 0001601851702 1901082607670001
4672
MAMAD ROSIDI
PESERTA
26/07/1967
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,229 0001601851713 1901086908680001
4672
ARNI
ISTRI
29/08/1968
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,230 0001601851724 1901086004650001
4674
NAZORI
PESERTA
20/04/1965
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,231 0001601851735 1901080507870001
4674
ASRIL
ANAK
05/07/1987
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,232 0001601851746 1901080107680002
4676
ROMLAH
PESERTA
01/07/1968
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,233 0001601851757 1901080107720003
4676
SAIPUL
TAMBAHAN
01/07/1977
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,234 0001601851768 1901080910820001
4678
KANDI
PESERTA
09/10/1982
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,235 0001601851779 1901086511870001
4678
MILA
ISTRI
25/11/1987
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,236 0001601851781 1901086512030001
4678
SELMA
ANAK
25/12/2003
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,237 0001601851792 1901080304530002
4681
DINHAK
PESERTA
03/04/1953
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,238 0001601851803 1901084104630001
4681
ROTENI
ISTRI
21/01/1963
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,239 0001601851814 1901082009840001
4684
JUPRI
PESERTA
20/09/1984
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,240 0001601851825 1901086204900001
4684
FITRI
ISTRI
22/04/1990
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 228 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,241 0001601851836 1901082909100001
4684
MUHAMMAD ZIKRI
ANAK
29/09/2010
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,242 0001601851847 1901086010590001
4687
NURAINI
PESERTA
20/10/1959
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,243 0001601851858 1901084107460001
4688
MARWAH
PESERTA
01/07/1944
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,244 0001601851869 1901080508720001
4689
LEO ISKANDAR
PESERTA
05/08/1972
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,245 0001601851871 1901085011720002
4689
FITRIWATI
ISTRI
10/11/1972
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,246 0001601851882 1901085106000002
4689
MEGA WARNIA
ANAK
11/06/2000
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,247 0001601851893 1901081710050001
4689
MUHAMAD SOBIRI
ANAK
17/10/2005
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,248 0001601851904 1901082111510001
4693
MURI
PESERTA
21/11/1951
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,249 0001601851915 1901080405880002
4693
SAPRIYADI
ANAK
04/05/1988
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,250 0001601851926 1901087008950002
4693
ERTIN PITARI
ANAK
30/08/1995
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,251 0001601851937 1901081901650001
4697
SAILAN BIN JAMAL
PESERTA
13/01/1968
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,252 0001601851948 1901085002740001
4697
JAHARA
ISTRI
10/02/1974
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,253 0001601851959 1901084703960001
4697
SIPI PITRI
ANAK
07/03/1996
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,254 0001601851961 1901082004570001
4700
ABDULLAH
PESERTA
20/04/1957
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,255 0001601851972 1901084101660001
4700
MAIMUNAH
ISTRI
01/01/1966
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,256 0001601851983 1901082910910001
4700
SUSANTO
ANAK
29/10/1991
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,257 0001601851994 1901084204780001
4703
NILAWATI
PESERTA
02/04/1978
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,258 0001601852005 1901080902980001
4703
SODRI
ANAK
09/02/1998
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,259 0001601852016 1901080902030001
4703
AGIL SUHENDRA
ANAK
09/02/2003
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,260 0001601852027 1901082212590001
4706
ROMADI
PESERTA
21/12/1959
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,261 0001601852038 1901084106620001
4706
SAHARA
ISTRI
14/07/1962
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,262 0001601852049 1901086003560001
4708
HASNI
PESERTA
20/03/1956
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,263 0001601852051 1901081611640003
4709
MUHAMAD ZAILANI
PESERTA
16/11/1964
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 229 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,264 0001601852062 1901086703640001
4709
BULKIS
ISTRI
27/03/1964
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,265 0001601852073 1901083012870001
4709
DICKY HARRI SANDI
ANAK
30/12/1987
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,266 0001601852084 1901082805990001
4709
SALAHUDIN ALAYUBI
ANAK
28/05/1999
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,267 0001601852095 1901080806070003
4709
MUHAMAD UNZIR
ANAK
08/06/2007
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,268 0001601852106 1901085207500001
4714
ANA
PESERTA
12/07/1958
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,269 0001601852117 1901086808950003
4714
NAZILA
ANAK
18/08/1995
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,270 0001601852128 1901081102490002
4716
MARZUKI
PESERTA
11/02/1949
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,271 0001601852139 1901085402530002
4716
HANATI
ISTRI
14/02/1953
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,272 0001601852141 1901040107790001
4718
SAPRIANDI
PESERTA
01/07/1979
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,273 0001601852152 1901084511770003
4718
MARINA
ISTRI
05/11/1977
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,274 0001601852163 1901084107580001
4720
SUHANA
PESERTA
01/07/1958
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,275 0001601852174 1901082006940002
4720
M.HANADI
ANAK
20/06/1994
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,276 0001601852185 1901084107500010
4723
PATIMAH
PESERTA
01/07/1950
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,277 0001601852196 1901080708850001
4723
MUHAMAD AMIN
ANAK
07/08/1985
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,278 0001601852207 1901080107640001
4725
YUSUF
PESERTA
01/07/1964
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,279 0001601852242 1901081607470001
4730
ABDUL JALIL
PESERTA
16/07/1947
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,280 0001601852253 1901084607600001
4730
MAIMUNAH
ISTRI
06/07/1960
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,281 0001601852264 1901080804460002
4732
MUHAMAD YAMIN
PESERTA
08/04/1946
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,282 0001601852275 1901086003510002
4732
ROMNAH
ISTRI
20/03/1951
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,283 0001601852286 1901086001500002
4734
YOLIANA
PESERTA
20/01/1950
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,284 0001601852297 1901081704850001
4734
ROZANI
ANAK
17/04/1985
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,285 0001601852308 1901085010560001
4736
MASIAH
PESERTA
10/10/1956
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,286 0001601852319 1901080210330001
4737
DULHADI
PESERTA
02/10/1933
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 230 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,287 0001601852321 1901080307580001
4737
ALI YASAK
TAMBAHAN
03/07/1958
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,288 0001601852332 1901084810630001
4739
SUMARNI
PESERTA
08/10/1963
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,289 0001601852343 1901085310900001
4739
ROMINA
ANAK
13/10/1990
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,290 0001601852354 1901081007950001
4739
SALMAN
ANAK
10/07/1995
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,291 0001601852365 1901086503880001
4742
SULYA
PESERTA
25/03/1988
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,292 0001601852376 1901087112110001
4742
DESTI KAYLA SOBRI
ANAK
31/12/2011
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,293 0001601852387 1901080107630002
4744
HAMSAH
PESERTA
01/07/1963
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,294 0001601852398 1901086312700001
4744
SALMI
ISTRI
23/12/1970
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,295 0001601852409 1901082206020001
4744
REZI
ANAK
22/06/2002
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,296 0001601852411 1901080107610001
4744
IDAN
TAMBAHAN
01/07/1961
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,297 0001601852422 1901080103800001
4744
MUHAMAD YANI
TAMBAHAN
29/02/1980
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,298 0001601852433 1901081011600001
4750
SAKRI
PESERTA
10/11/1960
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,299 0001601852444 1901084909650001
4750
HASNAH
ISTRI
09/09/1965
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,300 0001601852455 1901084107550001
4752
MAHAYA
PESERTA
01/07/1955
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,301 0001601852466 1901080706800001
4753
PERI
PESERTA
07/06/1980
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,302 0001601852477 1901086608830001
4753
ILYA
ISTRI
19/08/1983
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,303 0001601852488 1901082502060001
4753
BASRI
ANAK
25/02/2006
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,304 0001601852499 1901081002690001
4756
SUWANDI
PESERTA
10/02/1969
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,305 0001601852501 1901084403730001
4756
YATI
ISTRI
04/03/1973
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,306 0001601852512 1901084506960001
4756
ATIKA
ANAK
05/05/1996
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,307 0001601852523 1901084701780011
4759
YANTI
PESERTA
07/01/1978
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,308 0001601852534 1901082102470001
4760
FITRI
PESERTA
21/02/1947
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,309 0001601852545 1901084107480032
4760
SOPIAH
ISTRI
16/05/1949
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 231 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,310 0001601852556 1901080107790049
4760
MASURI
ANAK
22/08/1978
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
5,311 0001601852567 1901036808500001
4763
LO KIM TJION
PESERTA
28/08/1950
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,312 0001601852578 1901031608580001
4764
AGUS TARMAN
PESERTA
16/08/1958
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,313 0001601852589 1901036804580001
4764
MARYATI
ISTRI
28/04/1958
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,314 0001601852591 1901031905460001
4766
M. JAMIL
PESERTA
19/05/1946
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,315 0001601852602 1901035504470021
4766
MASNAH
ISTRI
15/04/1947
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,316 0001601852613 1901035106650001
4768
LIE MIE LIP
PESERTA
06/11/1965
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,317 0001601852624 1901034905080001
4768
TESIA ANUGRAH
ANAK
05/09/2008
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,318 0001601852635 1901034107590020
4770
ELIDA
PESERTA
07/01/1959
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,319 0001601852646 1901035101340001
4771
LIM JAT NYU
PESERTA
01/11/1934
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,320 0001601852657 1901034107450001
4772
LIAN KIN FUN
PESERTA
14/02/1944
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,321 0001601852668 1190103511150001
4773
LIONG ASUN
PESERTA
11/11/1950
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,322 0001601852679 1901035210010001
4773
MELA
ANAK
10/12/2001
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,323 0001601852681 1901031302520001
4775
NURMAN
PESERTA
13/02/1952
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,324 0001601852692 1901036404600001
4775
SURYATI
ISTRI
24/04/1960
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,325 0001601852703 1901030202640005
4777
EDDY
PESERTA
02/02/1964
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,326 0001601852714 1901036202690001
4777
RANITA
ISTRI
22/02/1969
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,327 0001601852725 1901031112690005
4779
SATIMAN
PESERTA
12/11/1969
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,328 0001601852736 1901035001690003
4779
NURHAYATI
ISTRI
01/10/1969
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,329 0001601852747 1901030607530001
4781
TJHIN FEN TJHUN
PESERTA
07/06/1953
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,330 0001601852758 1901031411090007
4783
YUHARDI
PESERTA
10/01/1965
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,331 0001601852769 1901032210550001
4784
MOI SUN TIAM
PESERTA
22/10/1955
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,332 0001601852771 1901031005500001
4785
SENAN
PESERTA
05/10/1950
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 232 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,333 0001601852782 1901031412430001
4786
RIZALI HADI
PESERTA
14/12/1943
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,334 0001601852793 1901031508560001
4787
SARIA
PESERTA
15/08/1956
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,335 0001601852804 1901032008600001
4788
ARODIN
PESERTA
20/08/1960
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,336 0001601852815 1901035212680002
4788
MARYADA
ISTRI
12/12/1968
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,337 0001601852826 1901032406660002
4790
AIDI
PESERTA
24/06/1966
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,338 0001601852837 1901036504690002
4790
SUPARMI
ISTRI
15/04/1969
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,339 0001601852848 1901033108720003
4792
ZULPIAN
PESERTA
31/08/1972
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,340 0001601852859 1901034102720001
4795
MAIMUNAH
PESERTA
02/01/1972
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,341 0001601852861 1901035602620002
4796
NINAWATI
PESERTA
16/02/1962
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,342 0001601852872 1901035911720001
4797
TOMIMAH
PESERTA
19/11/1972
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,343 0001601852883 1901035010500001
4799
ZAINUR BUJANG
PESERTA
10/10/1950
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,344 0001601852894 1901030408520001
4800
JAMALUDIN
PESERTA
08/04/1952
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,345 0001601852905 1901034107550020
4800
MAINAH
ISTRI
07/01/1955
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,346 0001601852916 1901031011960002
4800
NURHADI
ANAK
11/10/1995
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,347 0001601852927 1901032006410001
4804
ROSIAN
PESERTA
20/06/1941
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,348 0001601852938 1901031708630005
4805
AGUS ATENG
PESERTA
17/08/1963
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,349 0001601852949 1901034212630001
4805
RATNA
ISTRI
12/02/1963
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,350 0001601852951 1901031103450001
4807
KARSONO
PESERTA
03/11/1945
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,351 0001601852962 1901035401570001
4807
WAGINI
ISTRI
14/01/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,352 0001601852973 1901030709580001
4809
SOPIAN
PESERTA
09/07/1958
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,353 0001601852984 1901034107580021
4811
HAZIZAH
PESERTA
07/01/1958
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,354 0001601852995 1901034107800024
4811
MARIA NINGSIH
ANAK
07/01/1980
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,355 0001601853006 1901030107500016
4813
ALI SAHARI
PESERTA
07/01/1950
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:15 PM
Page 233 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,356 0001601853017 1901034909520042
4813
ASIAH
ISTRI
09/09/1952
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,357 0001601853028 1901031507560001
4816
SUKRI BAKAR
PESERTA
15/07/1956
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,358 0001601853039 1901030701730006
4817
BUJANG
PESERTA
26/11/1972
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,359 0001601853041 1901036903620001
4818
SAMSIAH
PESERTA
29/03/1962
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,360 0001601853052 1901034905560001
4819
SRIWATI
PESERTA
05/09/1958
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,361 0001601853063 1901030611310001
4821
H. ABDURRAHMAN
PESERTA
10/06/1931
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,362 0001601853074 1901036102370002
4821
HJ. HINDUN
ISTRI
21/02/1937
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,363 0001601853085 1901035201520001
4823
ROKIAH
PESERTA
01/12/1952
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,364 0001601853096 1901034107390008
4824
JAURAH
PESERTA
07/01/1939
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,365 0001601853107 1901035401370001
4825
HJ. AZIZAH
PESERTA
14/01/1937
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,366 0001601853118 1901032307570001
4826
RASID
PESERTA
23/07/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,367 0001601853129 1901034702780058
4827
SITI AISYAH
PESERTA
02/07/1978
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,368 0001601853131 1901034511830001
4827
NOVITA
TAMBAHAN
11/05/1983
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,369 0001601853142 1901035709640003
4830
SAMSIAH
PESERTA
17/09/1964
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,370 0001601853153 1901032308810003
4830
SYAH FITRI
ANAK
23/08/1931
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,371 0001601853164 1901030701570011
4832
ISMA'IL
PESERTA
01/07/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,372 0001601853175 1901031004500003
4834
IDRIS
PESERTA
04/10/1950
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,373 0001601853186 1901035004530001
4834
ROBI'AH
ISTRI
04/10/1953
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,374 0001601853197 1901031103400001
4836
RAHMAD BAGONG
PESERTA
03/11/1940
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,375 0001601853208 1901030202570001
4837
SYAMSURI
PESERTA
02/02/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,376 0001601853219 1901034207390001
4839
HASANAH
PESERTA
07/02/1939
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,377 0001601853221 1901030107450011
4840
ARIFIN B.SENU
PESERTA
07/01/1945
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,378 0001601853232 1901036005490002
4840
SURIDAH
ISTRI
20/05/1949
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 234 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,379 0001601853243 1901034107640019
4843
ROJI'AH
PESERTA
07/01/1964
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,380 0001601853254 1901030107510012
4843
ADLA
ISTRI
07/01/1951
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,381 0001601853265 1901036707790001
4845
SASTRI
PESERTA
27/07/1970
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,382 0001601853276 1901036708720040
4847
AGUSTINI
PESERTA
17/08/1972
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,383 0001601853287 1901031603640001
4848
RUSMANTONO
PESERTA
16/03/1964
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,384 0001601853298 1901030303490001
4849
YUSUF DERANI
PESERTA
03/03/1949
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,385 0001601853309 1901035401540001
4849
HATIJAH
ISTRI
14/01/1954
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,386 0001601853311 1901030808490001
4851
SARMAWI
PESERTA
08/08/1949
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,387 0001601853322 1901034407510001
4851
SAUYAH
ISTRI
14/07/1950
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,388 0001601853333 1901034408710001
4853
SALBIAH
PESERTA
08/04/1971
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,389 0001601853344 1901036810540002
4854
KHODIJAH
PESERTA
28/10/1954
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,390 0001601853355 1901030107350009
4855
SULAIMAN
PESERTA
07/01/1935
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,391 0001601853366 1901034107400006
4855
SUKIYAH
ISTRI
07/01/1940
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,392 0001601853377 1901034107390003
4857
ROBAKYAH
PESERTA
07/01/1939
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,393 0001601853388 1901030507540001
4858
ABDULLAH
PESERTA
07/06/1954
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,394 0001601853399 1901035508540002
4859
MILAWATI
PESERTA
15/08/1954
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,395 0001601853401 1901035708450001
4860
SAUYAH
PESERTA
17/08/1945
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,396 0001601853412 1901036411620001
4861
YURYATI
PESERTA
24/11/1962
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,397 0001601853423 1901035506390001
4862
HJ. ROKIAH
PESERTA
15/06/1939
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,398 0001601853434 1901035604420001
4863
HANINA
PESERTA
16/04/1942
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,399 0001601853445 1901034701560004
4864
AZRALINA
PESERTA
01/07/1956
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,400 0001601853456 1901034107450002
4865
UMI KALSUM
PESERTA
07/01/1945
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,401 0001601853467 1901030107600021
4866
RONI
PESERTA
07/01/1960
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 235 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,402 0001601853478 1901034110650001
4866
SUAILA
ISTRI
10/01/1965
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,403 0001601853489 1901031204450001
4868
SAMSUDIN
PESERTA
04/12/1945
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,404 0001601853491 1901034206470001
4868
MARINA
ISTRI
06/02/1947
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,405 0001601853502 1901035004480001
4870
SURYATI
PESERTA
04/10/1948
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,406 0001601853513 1901031909370004
4871
BUNYAMIN JAIS
PESERTA
19/09/1937
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,407 0001601853524 1901034701530004
4873
ROSNAH
PESERTA
01/07/1952
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,408 0001601853535 1901034101500003
4874
HAJIMA
PESERTA
07/01/1950
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,409 0001601853546 1901030510630001
4875
ZUMIZI
PESERTA
10/05/1963
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,410 0001601853557 1901031808390002
4877
RIDUAN ISMAIL
PESERTA
18/08/1939
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,411 0001601853568 1901032004450001
4878
MAT ALI
PESERTA
20/04/1945
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,412 0001601853579 1901035508540001
4879
ZUBAIDAH
PESERTA
15/08/1954
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,413 0001601853581 1901035708630001
4879
ROKHMAH
ISTRI
17/08/1963
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,414 0001601853592 1901030701690002
4881
M. RUSLAN EFFENDI
PESERTA
01/07/1969
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,415 0001601853603 1901030701600002
4883
JUMLI
PESERTA
02/05/1961
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,416 0001601853614 1901031906520001
4884
SURYADI
PESERTA
19/06/1952
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,417 0001601853625 1901030107370001
4885
H.M.YUNUS MENTOH
PESERTA
07/01/1937
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,418 0001601853636 1901034701620013
4885
ROPISAH
ISTRI
01/07/1962
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,419 0001601853647 1901034107670026
4887
SOLEHA
PESERTA
07/01/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,420 0001601853658 1901030504900002
4887
SANDI
ANAK
04/05/1990
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,421 0001601853669 1901030505810003
4889
CHAIRUDIN
PESERTA
05/05/1981
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,422 0001601853671 1901035802820002
4889
SRI WARTIKA
ISTRI
18/02/1982
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,423 0001601853682 1901035802040004
4889
SISKA FEBIOLA
ANAK
18/02/2004
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,424 0001601853693 1901031411060001
4889
AR RAFI NAJMUDIN
ANAK
14/11/2006
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 236 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,425 0001601853704 1901031809750001
4893
JUMLI
PESERTA
18/09/1975
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,426 0001601853715 1901034404790001
4893
YULENA
ISTRI
04/04/1979
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,427 0001601853726 1901034701670001
4895
ALI AKBAR
PESERTA
27/11/1967
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,428 0001601853737 1901034708690001
4895
YULYATI
ISTRI
07/08/1969
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,429 0001601853748 1901031712420001
4897
PAIMIN PALIL
PESERTA
17/12/1942
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,430 0001601853759 1901035607440001
4897
YAHYUTI
ISTRI
16/07/1944
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,431 0001601853761 1901035010640002
4900
JAURAH
PESERTA
10/10/1964
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,432 0001601853772 1901036709350001
4901
LIE AKHIUN
PESERTA
27/09/1935
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,433 0001601853783 1901031003530001
4902
ROMLI
PESERTA
07/01/1955
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,434 0001601853794 1901030503770001
4903
RAHMAN
PESERTA
03/05/1977
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,435 0001601853805 1901032206340001
4904
JAP HON TUNG
PESERTA
22/06/1934
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,436 0001601853816 1901035004520002
4908
HAYATI
PESERTA
04/10/1952
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,437 0001601853827 1901036210870001
4909
BOEN KHIUN DJIE
PESERTA
22/10/1987
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,438 0001601853838 1901035704510001
4911
SIP LUN
PESERTA
17/04/1951
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,439 0001601853849 1901034107710022
4912
MARDIAH
PESERTA
07/01/1971
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,440 0001601853851 1901036106750001
4913
ROSIDAH
PESERTA
21/06/1975
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,441 0001601853862 1901032204840001
4914
KARDI
PESERTA
22/04/1984
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,442 0001601853873 1901036505890001
4914
MARLIA GUSTI
ISTRI
25/05/1989
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,443 0001601853884 1901033003600001
4916
BAMBANG .B
PESERTA
30/03/1960
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,444 0001601853895 1901034607690002
4916
IIN MARSINAH
ISTRI
07/06/1969
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,445 0001601853906 1901031404620001
4921
MUSLIMIN
PESERTA
14/04/1962
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,446 0001601853917 1901030809580001
4922
SAHRI
PESERTA
09/08/1958
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,447 0001601853928 1901034509600001
4922
MAIMUNAH
ISTRI
08/05/1960
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 237 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,448 0001601853939 1901034701580004
4925
SAKNIAH
PESERTA
01/07/1958
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,449 0001601853941 1901034101690001
4926
HOTIMAH
PESERTA
07/01/1968
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,450 0001601853952 1901030111680001
4927
JUNAIDI
PESERTA
11/01/1968
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,451 0001601853963 1901034409670001
4927
HAZIAH
ISTRI
04/09/1967
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,452 0001601853974 1901031604590001
4929
ARSUKLI
PESERTA
16/04/1959
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,453 0001601853985 1901034709970002
4929
ANIS KORLELA
ANAK
09/07/1997
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,454 0001601853996 1901030310780001
4931
IDHAM
PESERTA
10/03/1978
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,455 0001601854007 1901035201810001
4931
FITRIYANA
TAMBAHAN
01/12/1981
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,456 0001601854018 1901030508740001
4934
SYAMSURI
PESERTA
08/05/1974
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,457 0001601854029 1901034408770001
4934
HEFFY
ISTRI
08/04/1977
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,458 0001601854031 1901036104010004
4934
APRILIA DAMAYANTI
ANAK
21/04/2001
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,459 0001601854042 1901033011060001
4934
M.FAUZAN.I
ANAK
30/11/2006
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,460 0001601854053 1901030308840001
4938
AGUS SUGIANTO
PESERTA
08/03/1984
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,461 0001601854064 1901033011900003
4938
DENI
ANAK
30/11/1990
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,462 0001601854075 1901030106520004
4943
Boen tian Djiu
PESERTA
06/01/1952
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,463 0001601854086 1901036708570003
4943
Aina Basuki
ISTRI
27/08/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,464 0001601854097 1901030505640004
4945
QOMARUDIN
PESERTA
05/05/1964
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,465 0001601854108 1901034107730019
4945
SOFIAH
ISTRI
01/07/1973
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,466 0001601854119 1901030505940002
4945
ALIL ABSOR
ANAK
05/05/1994
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,467 0001601854121 1901030709990003
4945
MUHAMAD ASLAM
ANAK
07/09/1999
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,468 0001601854132 1901032502010003
4945
TOSIN
ANAK
25/02/2001
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,469 0001601854143 1901034307050002
4945
USWATUN HASANAH
ANAK
03/07/2005
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,470 0001601854154 1901030701580003
4951
JAMHER
PESERTA
07/01/1958
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 238 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,471 0001601854165 1901034701680003
4951
SITI HAURA
ISTRI
07/01/1968
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,472 0001601854176 1901034101930001
4951
NUR RIZKI
ANAK
01/01/1993
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,473 0001601854187 1901032509950002
4951
MUHAMAD JUNAIDI
ANAK
25/09/1994
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,474 0001601854198 1901035101970001
4951
SUCI RAHMADINI
ANAK
01/01/1997
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,475 0001601854209 1901031309020001
4951
RICO HARDYANSYAH
ANAK
13/09/2002
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,476 0001601854211 1901030408350001
4957
UMAR TENGKU
PESERTA
04/08/1935
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,477 0001601854222 1901034108560002
4957
ROPIAH
ISTRI
01/08/1956
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,478 0001601854233 1901031506900002
4957
MIDUN HABIBI
ANAK
15/06/1990
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,479 0001601854244 1901034107680030
4960
MAINU
PESERTA
01/07/1968
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,480 0001601854255 1901030507880001
4960
AHMAD REVENDI
ANAK
05/07/1988
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,481 0001601854266 1901031208940001
4960
VAHRUL ROZI
ANAK
12/08/1994
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,482 0001601854277 1901030102000001
4960
FAJAR RONI
ANAK
01/02/2000
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,483 0001601854288 1901034207650003
4964
SOLEHA
PESERTA
02/07/1965
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,484 0001601854299 1901034804920001
4964
SITI FATIMAH
ANAK
08/04/1992
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,485 0001601854301 1901031706990003
4964
SULAIMAN
ANAK
17/06/1999
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,486 0001601854312 1901032411040003
4964
BUDI ARDIANSYAH
ANAK
24/11/2004
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,487 0001601854323 1901034107540018
4968
HASANAH
PESERTA
01/07/1954
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,488 0001601854334 1901030107740016
4968
M.ROZIK
ANAK
01/07/1974
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,489 0001601854345 1901034605580001
4970
MAIMUNAH
PESERTA
06/05/1958
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,490 0001601854356 1901034404990002
4970
SARI PURWATI
ANAK
04/04/1999
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,491 0001601854367 1901030107780022
4972
MUSLIMUN
PESERTA
01/07/1978
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,492 0001601854378 1901034107800032
4972
SUMARNI
ISTRI
01/07/1980
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,493 0001601854389 1901035011970001
4972
JURAIRIAH
ANAK
10/11/1997
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 239 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,494 0001601854391 1901034109000002
4972
HAMSIAH
ANAK
01/09/2000
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,495 0001601854402 1901036408020001
4972
SARINA
ANAK
24/08/2002
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,496 0001601854413 1901034605070003
4972
MEDITA ASMIRADA
ANAK
06/05/2007
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,497 0001601854424 1901032008720002
4978
SAPRIYANTO
PESERTA
20/08/1972
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,498 0001601854435 1901037011760001
4978
RUMSIAH
ISTRI
30/11/1976
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,499 0001601854446 1901032507980001
4978
MUHAMAD HOLIL
ANAK
25/07/1998
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,500 0001601854457 1901032105030001
4978
MUHAMAD TOHA
ANAK
21/05/2003
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,501 0001601854468 1901031803080001
4978
MULIZAN
ANAK
18/03/2008
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,502 0001601854479 1901031011110001
4978
AHMAD ASBULLAH
ANAK
10/11/2011
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,503 0001601854481 1901031507720001
4984
A. GANI
PESERTA
15/07/1972
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,504 0001601854492 1901035111730005
4984
JAMILAH
ISTRI
11/11/1973
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,505 0001601854503 1901031111950001
4984
AHMAD SAHLA
ANAK
11/11/1995
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,506 0001601854514 1901031007970003
4984
MAULANA ALI
ANAK
10/07/1997
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,507 0001601854525 1901035003030001
4984
SITI MARYAM
ANAK
10/03/2003
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,508 0001601854536 1901031712120001
4984
MUHAMMAD FIKRI
ANAK
17/12/2012
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,509 0001601854547 1901010107610028
4990
MILIN
PESERTA
01/07/1961
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,510 0001601854558 1901016601730001
4990
ZUHRIAH
ISTRI
26/01/1973
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,511 0001601854569 1901011208070001
4990
DAFA GUSTIAN SAPUTRA
ANAK
12/08/2007
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,512 0001601854571 1901035104120001
4990
ZAHIRA
ANAK
11/04/2012
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,513 0001601854582 1901036712640001
4994
ANI ASARI
PESERTA
27/12/1964
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,514 0001601854593 1901031006890002
4994
M. JUNAIDI
ISTRI
10/06/1989
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,515 0001601854604 1901034206610001
4996
SARMILAWATI
PESERTA
02/06/1961
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,516 0001601854615 1901034404970002
4996
ALYA
ANAK
04/04/1997
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 240 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,517 0001601854626 1901036302000001
4996
ALITA
ANAK
23/02/2000
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,518 0001601854637 1901030208030001
4996
SAHRIL USMAN
ANAK
02/08/2003
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,519 0001601854648 1901031005850002
5000
YAUMIL
PESERTA
10/05/1985
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,520 0001601854659 1901034705830004
5000
SUAIBAH
ISTRI
07/05/1983
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,521 0001601854661 1901030109110004
5000
MUHAMMAD IZAZUL
ANAK
01/09/2011
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,522 0001601854672 1901032606780001
5003
IDRIS
PESERTA
26/06/1978
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,523 0001601854683 1901036709840003
5003
SITI AISYAH
ISTRI
27/09/1984
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,524 0001601854694 1901031310080001
5003
ADZIM ALFARUQI
ANAK
13/10/2008
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,525 0001601854705 1971040410780001
5006
IWAN
PESERTA
04/10/1978
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,526 0001601854716 1971044202770001
5006
FARDALINAH
ISTRI
02/02/1977
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,527 0001601854727 1901031210640001
5008
ISHAK
PESERTA
12/10/1964
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,528 0001601854738 1901035409640003
5008
NURAINI
ISTRI
14/09/1964
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,529 0001601854749 1901034610950002
5008
JURAIDAH
ANAK
06/10/1995
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,530 0001601854751 1901036003980003
5008
JAMILAH
ANAK
20/03/1998
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,531 0001601854762 1901032005050004
5008
AHMAD MUSLIM
ANAK
20/05/2005
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,532 0001601854773 1901032504770003
5013
SAMSUMIN
PESERTA
25/04/1977
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,533 0001601854784 1901034701810011
5013
NURASIAH
ISTRI
07/01/1981
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,534 0001601854795 1901037005020002
5013
ROZITA MIFTAHUL JANNAH
ANAK
30/05/2002
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,535 0001601854806 1901035105080003
5013
SUCI HUMAIROH
ANAK
11/05/2008
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,536 0001601854817 1901034211110003
5013
AZZA LATIFAH
ANAK
02/11/2011
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,537 0001601854828 1901031106800002
5018
ABU BAKAR
PESERTA
11/06/1980
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,538 0001601854839 1901034107830024
5018
ERNA WATI
ISTRI
01/07/1983
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,539 0001601854841 1901032604060002
5018
RIDUAN
ANAK
26/04/2006
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 241 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,540 0001601854852 1901035805100002
5018
PUTRI
ANAK
18/05/2010
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,541 0001601854863 1901030107610015
5022
SALEH
PESERTA
01/07/1961
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,542 0001601854874 1901035708770001
5022
SITI MARYAM
ISTRI
17/08/1977
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,543 0001601854885 1901031303020001
5022
IRPANSYAH
ANAK
13/03/2002
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,544 0001601854896 1901031303080002
5022
ZAKARIA
ANAK
13/03/2008
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,545 0001601854907 1901030608680002
5026
SUHARDI
PESERTA
06/08/1968
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,546 0001601854918 1901034107760011
5026
ROSIDAH
ISTRI
01/07/1976
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,547 0001601854929 1901031412950000
5026
MIZANUL AMIK
ANAK
14/12/1995
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,548 0001601854931 1901030107010017
5026
M.FAJRI
ANAK
01/07/2001
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,549 0001601854942 1901030108040002
5026
IZAM PUTRA
ANAK
01/08/2004
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,550 0001601854953 1901032207650001
5031
ASNAWI
PESERTA
22/07/1965
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,551 0001601854964 1901035604690003
5031
SITI MARYAM
ISTRI
15/04/1969
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,552 0001601854975 1901035201810002
5031
ROMISAH
ANAK
12/01/1981
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,553 0001601854986 1901035310870002
5031
ROHANI
ANAK
13/10/1988
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,554 0001601854997 1901030904890003
5031
SUBHAN
ANAK
09/04/1989
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,555 0001601855008 1901030703990005
5031
PASRAH ROMADON
ANAK
07/03/1999
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,556 0001601855019 1901030210040001
5031
JAMALUDIN ILHAM
ANAK
02/10/2004
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,557 0001601855021 1901030301690001
5038
SUHERMAN
PESERTA
03/01/1969
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,558 0001601855032 1901035404840001
5038
RODIYANA
ISTRI
14/04/1984
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,559 0001601855043 1901035104050001
5038
SUAIBARRURAHMA
ANAK
11/04/2005
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,560 0001601855054 1901034704090001
5038
TIARA HERDIYANI
ANAK
07/04/2009
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,561 0001601855065 1901031705130003
5038
FIKRI HERDIANSYAH
ANAK
17/05/2013
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,562 0001601855076 1901031605660001
5043
MUSTAR
PESERTA
16/05/1966
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 242 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,563 0001601855087 1901034512670001
5043
JAURIAH
ISTRI
05/12/1967
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,564 0001601855098 1901030508020001
5043
SAMIR HAMZAH
ANAK
05/08/2002
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,565 0001601855109 1901031011870006
5047
ARPAH HAMBALI
PESERTA
25/06/1987
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,566 0001601855111 1901034106960003
5047
ROSIDAH
ISTRI
06/02/1986
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,567 0001601855122 1901031609110001
5047
FADLI RISALI
ANAK
16/09/2011
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,568 0001601855133 1901034411130002
5047
NOVA MAHARANI
ANAK
04/11/2013
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,569 0001601855144 1901031105660001
5051
MASRHOKAN
PESERTA
11/05/1966
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,570 0001601855155 1901034911690001
5051
MARBIYAH
ISTRI
09/11/1969
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,571 0001601855166 1901031201000001
5051
MUHAMMAD YUSRIL
ANAK
12/01/2000
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,572 0001601855177 1901031802020001
5051
HENDRI
ANAK
18/02/2002
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,573 0001601855188 1901031808670001
5055
ROHIMI
PESERTA
18/08/1967
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,574 0001601855199 1901036409690001
5055
RACHMA
ISTRI
24/09/1969
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,575 0001601855201 1901032412940001
5055
DESRI
ANAK
24/12/1994
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,576 0001601855212 1901030311070001
5055
NOPRI
ANAK
03/11/1997
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,577 0001601855223 1901038111020001
5055
RAHMAYANTI
ANAK
11/11/2002
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,578 0001601855234 1901030506500001
5060
DULHADI KADAR
PESERTA
05/06/1950
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,579 0001601855245 1901034209490001
5060
SALBIAH
ISTRI
02/09/1949
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,580 0001601855256 1901031604480001
5062
ABU BAKAR H.A
PESERTA
16/04/1944
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,581 0001601855267 1901036108490002
5062
ROMINAH K
ISTRI
21/04/1948
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,582 0001601855278 1901035610560001
5064
AISAH
PESERTA
16/10/1956
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,583 0001601855289 1901034507590001
5065
AINI
PESERTA
05/07/1959
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,584 0001601855291 1901034211950005
5065
MARYAM
ANAK
02/11/1995
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,585 0001601855302 1901032109960003
5065
HARIS
ANAK
21/09/1996
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 243 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,586 0001601855313 1901032410980001
5065
PINDRA
ANAK
24/10/1998
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,587 0001601855335 1901030503530002
5070
SAPARDI
PESERTA
05/03/1953
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,588 0001601855346 1901034701560002
5070
ROMSIAH
ISTRI
07/02/1956
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,589 0001601855357 1901031805870002
5072
ABU BAKAR SIDIK
PESERTA
18/05/1987
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,590 0001601855368 1901035707930002
5072
MELAN YULYANA
ISTRI
17/07/1993
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,591 0001601855379 1901032702130001
5072
MUHAMAD HABIL
FEBRIANSYAH
ANAK
27/02/2013
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,592 0001601855381 1901030107610017
5075
ABDUL HAMID
PESERTA
01/07/1961
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,593 0001601855392 1901034310730004
5075
SITI AISYAH
ISTRI
03/10/1973
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,594 0001601855403 1901031208930001
5075
ABDUL SOBUR
ANAK
12/08/1993
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,595 0001601855414 1901032101970001
5075
HENDI SAPUTRA
ANAK
21/01/1997
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,596 0001601855425 1901036510980001
5075
SISKA OKTAVIA
ANAK
25/10/1998
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,597 0001601855436 1901031707070001
5075
IHSAN ALFIKRI
ANAK
17/07/2007
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,598 0001601855447 1901030107640004
5081
SAIDIN
PESERTA
01/07/1964
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,599 0001601855458 1901034107740002
5081
MAISAROH
ISTRI
01/07/1974
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,600 0001601855469 1901030505640006
5083
MUHAMAD YUSUF
PESERTA
05/05/1964
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,601 0001601855471 1901034107690022
5083
MAIMUNAH
ISTRI
01/07/1969
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,602 0001601855482 1901030101430001
5085
HASAN B
PESERTA
01/01/1943
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,603 0001601855493 1901036710570001
5085
PAULINA
ISTRI
27/10/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,604 0001601855504 1901036205610001
5087
MISTARI
PESERTA
22/05/1961
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,605 0001601855515 1901036701940001
5087
ROSMI
ANAK
17/01/1994
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,606 0001601855526 1901032706030001
5087
M YUNUS
ANAK
27/06/2003
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,607 0001601855537 1901034110080001
5087
WULANDARI
ANAK
01/10/2008
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,608 0001601855548 1901031703600001
5091
AINUDDIN
PESERTA
17/03/1960
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 244 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,609 0001601855559 1901035011770001
5091
NURHAYATI
ISTRI
10/11/1977
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,610 0001601855561 1901034701000008
5091
INA AIDINA
ANAK
07/01/2000
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,611 0001601855572 1901031002070001
5091
YOGA PRATAMA
ANAK
10/02/2007
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,612 0001601855583 1901032308090001
5091
FERRYYANSYAH
ANAK
23/08/2009
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,613 0001601855594 1901032411130001
5096
JIO FARIS
PESERTA
24/11/2013
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,614 0001601855605 1901030710580002
5097
AMSAR ALI
PESERTA
07/10/1958
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,615 0001601855616 1901034807670001
5097
HERITA
ISTRI
08/07/1967
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,616 0001601855627 1901034101430001
5099
ASIAH
PESERTA
01/01/1943
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,617 0001601855638 1901030602730002
5101
JUMLI
PESERTA
06/02/1973
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,618 0001601855649 1901032108800003
5101
ERWIN
ANAK
21/08/1980
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,619 0001601855651 1901030107510011
5104
HAKIAH
PESERTA
01/07/1951
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,620 0001601855662 1901030912800002
5105
JAMINAL
PESERTA
09/12/1980
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,621 0001601855673 1901031805050002
5105
ALFANDI
ANAK
18/05/2005
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,622 0001601855684 1901032509720001
5107
ABDUL WAHAB
PESERTA
25/09/1972
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,623 0001601855695 1901031309990001
5107
RENDI PRATAMA
ANAK
13/09/1999
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,624 0001601855706 1901032504030001
5107
GUNAWAN
ANAK
25/04/2003
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,625 0001601855717 1901035112040002
5107
RATIH SAFITRI
ANAK
11/12/2004
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,626 0001601855728 1901034412290001
5111
BUNG KHUFA
PESERTA
04/12/1929
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,627 0001601855739 1901032608650001
5115
LO AKWET
PESERTA
26/08/1965
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,628 0001601855741 1901036702580001
5117
HARYATI
PESERTA
27/02/1958
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,629 0001601855752 1901036908620001
5117
SUMARTINI
ISTRI
19/08/1962
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,630 0001601855763 1901036403650002
5119
ROSINA
PESERTA
24/03/1965
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,631 0001601855774 1901036107760001
5120
DARMIYANTI
PESERTA
21/07/1976
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 245 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,632 0001601855796 1901031203400002
5122
A.RAZAK
PESERTA
12/03/1940
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,633 0001601855807 1901034203470001
5124
NORIAH
PESERTA
02/03/1947
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,634 0001601855818 1901035003320001
5125
HJ. INDON
PESERTA
10/03/1932
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,635 0001601855829 1901035506400001
5126
HAFIFAH
PESERTA
15/06/1940
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,636 0001601855831 1901034502580002
5127
SOLIA
PESERTA
05/02/1958
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,637 0001601855842 1901031205600003
5128
YUSUF
PESERTA
12/05/1960
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,638 0001601855853 1901036905640001
5128
MAIMUNAH
ISTRI
29/05/1964
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,639 0001601855864 1901030812030002
5128
AHMAD SAWALDI
ANAK
08/12/2003
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,640 0001601855875 1901032601500001
5132
JUBRI
PESERTA
26/01/1950
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,641 0001601855886 1901034309460001
5132
AISYAH
ISTRI
03/09/1946
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,642 0001601855897 1901034804600004
5134
SALMAH
PESERTA
08/04/1960
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,643 0001601855908 1901031404880002
5134
ISKANDAR
ANAK
14/04/1988
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,644 0001601855919 1901034903550001
5137
KASTI
PESERTA
09/03/1955
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,645 0001601855921 1901034110380001
5138
HJ. BAHARAH
PESERTA
01/10/1938
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,646 0001601855932 1901036504350002
5139
SURIDA
PESERTA
25/04/1935
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,647 0001601855943 1901035605570001
5139
ROSMALA
TAMBAHAN
16/05/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,648 0001601855954 1901035004280001
5141
HOTIJAH
PESERTA
10/04/1928
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,649 0001601855965 1901035302530002
5142
CIK NUNI BINTI MUHAMAD
PESERTA
13/02/1953
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,650 0001601855976 1901032207970001
5143
EKO TEMPAT
PESERTA
22/07/1997
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,651 0001601855987 1901035205670006
5143
SETIMAH
TAMBAHAN
12/05/1967
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,652 0001601855998 1901035003380001
5146
ZURIAH
PESERTA
10/03/1938
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,653 0001601856009 1901031804480002
5148
BASTIAR
PESERTA
18/04/1948
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,654 0001601856011 1901031210520001
5150
KISMAN
PESERTA
12/10/1952
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 246 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,655 0001601856022 1901034806600001
5150
NAHUDA
ISTRI
08/06/1960
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,656 0001601856033 1901032405410001
5152
SALEH
PESERTA
24/05/1941
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,657 0001601856044 1901030109070002
5155
RIDO
PESERTA
01/09/2007
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,658 0001601856055 1607130107790115
5156
ALAMSYAH
PESERTA
01/07/1979
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,659 0001601856066 1607134107830187
5156
MARYUNI
ISTRI
01/07/1983
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,660 0001601856077 1607132610030001
5156
HIKMARAYA
ANAK
26/10/2003
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,661 0001601856088 1607133101060002
5156
SAIFUL ILLAHI
ANAK
31/01/2006
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,662 0001601856099 1607130308080004
5156
AGUS SUTIAWAN
ANAK
03/08/2008
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,663 0001601856101 1901032708780003
5161
HENDI
PESERTA
27/08/1974
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,664 0001601856112 1901031008740006
5162
HENDRY
PESERTA
10/08/1974
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,665 0001601856123 1901034806750002
5162
JURAIDAH
ISTRI
08/06/1975
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,666 0001601856134 1901031302030004
5162
ZARNOBI
ANAK
13/02/2003
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,667 0001601856145 1901031708040003
5162
KEVIN GUSTIO
ANAK
17/08/2004
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,668 0001601856156 1901037010110002
5162
ARTIKA SARI
ANAK
30/10/2011
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,669 0001601856167 1901034110530001
5168
NUN LIE
PESERTA
10/01/1953
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,670 0001601856178 1901036307390001
5169
KO CE GIM
PESERTA
13/07/1939
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,671 0001601856189 1901036303560001
5170
TURIAH
PESERTA
23/03/1956
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,672 0001601856191 1901032508320001
5171
KHIAN PIN
PESERTA
28/08/1932
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,673 0001601856202 1901022412310003
5172
PHAN MOEK TJO
PESERTA
24/12/1931
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,674 0001601856213 1901031003410002
5173
TJHIN LAN SIT
PESERTA
10/03/1941
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,675 0001601856224 1901036601520001
5174
DJAISAH
PESERTA
26/01/1952
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,676 0001601856235 1901030204650002
5176
SIAK FI
PESERTA
04/01/1965
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,677 0001601856246 1901036103260001
5176
DJONG KIUK FA
TAMBAHAN
14/07/1925
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 247 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,678 0001601856257 1901030506550002
5177
KONG BUN CUNG
PESERTA
06/06/1955
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,679 0001601856268 1901035712730003
5178
PUJI ASTUTI
PESERTA
17/12/1973
dr. ROY JHANNA GINTING SUKA
01/01/2015
AKTIF
19,225
30/12/2014
5,680 0001601856279 1901035401970003
5178
JENNYTA LAURENSYA JOHAN ANAK
14/01/1997
01/01/2015
AKTIF
19,225
30/12/2014
5,681 0001601856281 1901031705000002
5178
DHENNY ANDRIANTO JOHAN
ANAK
17/05/2002
01/01/2015
AKTIF
19,225
30/12/2014
5,682 0001601856292 1901031003720001
5181
RIYAN
PESERTA
02/10/1972
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,683 0001601856303 1901035006760003
5181
MUJINAH
ISTRI
04/10/1976
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,684 0001601856314 1901031101010002
5181
RICKY DEWA SATRIA
ANAK
01/11/2001
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,685 0001601856325 1901032505090004
5181
RINO
ANAK
25/05/2008
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,686 0001601856336 1901034108580001
5185
TJOE TEN FOENG
PESERTA
01/08/1958
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,687 0001601856347 1901031408560001
5186
TJO ON
PESERTA
14/08/1958
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,688 0001601856358 1901035511540001
5186
FA JAN
ISTRI
15/11/1954
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,689 0001601856369 1901036103400002
5190
KIM FONG
PESERTA
31/03/1940
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,690 0001601856371 1901035205430001
5191
A KONG
PESERTA
05/12/1943
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,691 0001601856382 1901030307350002
5193
NG DJIN MIN
PESERTA
03/07/1935
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,692 0001601856393 1901040409460001
5193
KIAM FUNG
ISTRI
04/09/1946
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,693 0001601856404 1901034603780002
5193
WEI TJHUN
ANAK
03/06/1978
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,694 0001601856415 1901036410570003
5196
SIN HIONG
PESERTA
14/10/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,695 0001601856426 1901030306780004
5196
KIM NYAN
ANAK
05/03/1978
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,696 0001601856437 1901036105640001
5198
ISLANTY
PESERTA
21/05/1964
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,697 0001601856448 1901038302960001
5198
SUSANTI
ANAK
23/02/1996
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,698 0001601856459 1901031411075805
5200
FATMAWATI
PESERTA
03/06/1926
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,699 0001601856461 1901031501550001
5201
CONG HIAN ON
PESERTA
15/01/1955
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,700 0001601856472 1901035711780954
5201
SIAK HO
ISTRI
17/11/1978
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 248 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,701 0001601856483 1901031711580953
5204
SAMIN SAHAK
PESERTA
17/11/1958
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,702 0001601856494 1901031409440001
5205
NAM HIAN
PESERTA
14/09/1944
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,703 0001601856505 1901030508470001
5206
LIE FA TET
PESERTA
05/08/1947
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,704 0001601856516 1901035608530001
5206
NG KIM THIN
ISTRI
16/06/1953
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,705 0001601856527 1901032202570002
5208
PAI MUN
PESERTA
22/02/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,706 0001601856538 1901030905810003
5208
ERWINSYAH
ANAK
05/09/1981
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,707 0001601856549 1901030607510002
5210
BUN HIAN DJIN
PESERTA
07/06/1951
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,708 0001601856551 1901034102630002
5210
LIONG MIE NON
ISTRI
02/01/1963
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,709 0001601856562 1901033112880002
5212
TJHIN CEN SIONG
PESERTA
30/11/1988
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,710 0001601856573 1901030511510003
5213
RUSLI
PESERTA
11/05/1951
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,711 0001601856584 1901030102520001
5213
RUSDI
TAMBAHAN
02/01/1952
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,712 0001601856595 1901034111440001
5213
HALIZAH
TAMBAHAN
16/08/2000
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,713 0001601856606 1901031208480001
5216
NG MAN CIN
PESERTA
12/08/1948
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,714 0001601856617 1901034805500001
5216
KHIUK JAN
ISTRI
09/05/1950
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,715 0001601856628 1901034311760001
5216
SAK YOEN
ANAK
03/11/1975
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,716 0001601856639 1901034308540001
5219
KHIUK DY
PESERTA
03/08/1954
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,717 0001601856641 1901035307370001
5220
KIAN A NYA
PESERTA
13/07/1937
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,718 0001601856652 1901036007620001
5221
KIM LIE
PESERTA
20/07/1962
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,719 0001601856663 1901034812860003
5221
YUNIARTI
ANAK
08/12/1986
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,720 0001601856674 1901036406570001
5223
DJIOE TJIOE MOEK
PESERTA
24/06/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,721 0001601856685 1901035109490001
5223
FATMAWATI
ISTRI
09/11/1949
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,722 0001601856696 1901036207700001
5225
A SIAN
PESERTA
22/07/1970
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,723 0001601856707 1901036907690002
5227
JULIA FRANTJE
PESERTA
29/07/1969
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 249 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,724 0001601856718 1901034409490001
5228
BUN NYUK SIAN
PESERTA
25/09/1949
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,725 0001601856729 1901034511530001
5229
LIE SIAN NYONG
PESERTA
05/11/1953
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,726 0001601856731 1901032301600001
5230
SIAT LIE
PESERTA
23/10/1960
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,727 0001601856742 1901031705570001
5232
DJAN NAM LIONG
PESERTA
17/05/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,728 0001601856753 1901034610360001
5233
TJIN LAN SIT
PESERTA
06/10/1936
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,729 0001601856764 1901035804470002
5234
MIE LION
PESERTA
16/06/1941
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,730 0001601856775 1901031001290001
5235
Lie Khin Siong
PESERTA
10/10/1929
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,731 0001601856786 1901034710470001
5235
Angit
ISTRI
07/01/1947
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,732 0001601856797 1901035501750001
5237
Lie Mei Sin
PESERTA
15/08/1975
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,733 0001601856808 1901034807990001
5237
Santi
ANAK
08/07/1999
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,734 0001601856819 1901032402080001
5237
Aldi
ANAK
24/02/2008
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,735 0001601856821 1901032402080002
5237
Aldo
ANAK
24/02/2008
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,736 0001601856832 1901035606580001
5241
Lie A Siat
PESERTA
16/06/1958
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,737 0001601856843 1901030507910002
5241
Akian
ANAK
05/07/1991
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,738 0001601856854 1901036003960002
5241
Meli
ANAK
20/03/1996
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,739 0001601856865 1901031506990003
5241
Ahen
ANAK
15/06/1999
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,740 0001601856876 1901034910710001
5245
Phung Sak Fa
PESERTA
09/10/1971
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,741 0001601856887 1901032402950001
5245
Randi Yulianto
ANAK
24/02/1995
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,742 0001601856898 1901035502020001
5245
Dafitri
ANAK
15/02/2002
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,743 0001601856909 1901035605400001
5248
Phoe Siak Wan
PESERTA
16/05/1940
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,744 0001601856911 1901035305390001
5250
Tjhang A Moy
PESERTA
15/03/1939
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,745 0001601856922 1901035204590002
5251
Hiw Moij Djan
PESERTA
12/04/1959
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,746 0001601856933 1901032212380001
5252
Tjhin Khim Hak
PESERTA
22/12/1938
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 250 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,747 0001601856944 1901030808510001
5253
Nam Phi
PESERTA
08/08/1951
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,748 0001601856955 1901035611550001
5253
Nam Phian
TAMBAHAN
16/11/1955
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,749 0001601856966 1901036908470001
5255
Afung
PESERTA
29/08/1947
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,750 0001601856977 1901030909400001
5255
Sin Ho
ANAK
09/09/1994
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,751 0001601856988 1901037008500001
5257
A Kiang
PESERTA
30/08/1950
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,752 0001601856999 1901034101680003
5258
Ratna
PESERTA
01/01/1968
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,753 0001601857001 1901032112540002
5259
Farhan
PESERTA
21/12/1954
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,754 0001601857012 1901036109540001
5259
Kho Siu Tjhin
ISTRI
21/09/1954
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,755 0001601857023 1901032711790001
5259
Yung Yung
ANAK
27/11/1979
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,756 0001601857034 1901031205810001
5259
Sun Sun
ANAK
12/05/1981
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,757 0001601857045 1901032212820003
5259
Liang Liang
ANAK
22/12/1982
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,758 0001601857056 1901031302590001
5264
Tjong Hoi Tet
PESERTA
13/02/1959
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,759 0001601857067 1901030311550001
5265
Moek Lioeng
PESERTA
03/11/1955
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,760 0001601857078 1901036210600002
5265
Kang Njoen
TAMBAHAN
22/10/1960
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,761 0001601857089 1901031508620001
5265
Khim Fat
TAMBAHAN
15/08/1962
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,762 0001601857091 1901031210420001
5268
Cong Muk Bong
PESERTA
12/10/1942
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,763 0001601857102 1901032112870001
5268
Jiw Liw
ANAK
21/12/1987
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,764 0001601857113 1901032001460001
5268
Cung Muk Khiong
TAMBAHAN
20/01/1946
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,765 0001601857124 1901032007280001
5271
Lo Ngiam To
PESERTA
20/07/1928
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,766 0001601857135 1901032110630001
5272
Purnomo
PESERTA
20/10/1963
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,767 0001601857146 1901036303720001
5272
Me Ling
ISTRI
23/03/1997
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,768 0001601857157 1901031608970001
5272
Agus Hindarto
ANAK
16/08/1997
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,769 0001601857168 1901033005000001
5272
Mario Hindarto
ANAK
30/05/2000
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 251 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,770 0001601857179 1901034805020002
5272
Meiriyanti Mandasari
ANAK
08/05/2002
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,771 0001601857181 1901031602040001
5272
Jefri
ANAK
16/02/2004
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,772 0001601857192 1901032508050001
5272
Gunawan Gusnadi
ANAK
25/08/2002
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,773 0001601857203 1901034809570002
5279
Loing A Ngo
PESERTA
08/09/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,774 0001601857214 1901034704620001
5280
Betty Susana
PESERTA
07/04/1962
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,775 0001601857225 1901036601980002
5280
Monica
ANAK
26/01/1998
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,776 0001601857236 1901031111390001
5282
Bong Khi Jam
PESERTA
11/11/1939
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,777 0001601857247 1901035112500002
5282
Tjoeng Sak Muk
ISTRI
11/12/1950
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,778 0001601857258 1901030109600003
5284
Hasyim
PESERTA
01/09/1960
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,779 0001601857269 1901036802670001
5284
Chai Sak Moy
ISTRI
28/02/1967
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,780 0001601857271 1901035601310001
5286
Lim Muk Djin
PESERTA
16/01/1931
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,781 0001601857282 1901031008560001
5287
Bun Ato
PESERTA
10/08/1955
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,782 0001601857293 1901036806210001
5288
Ng a Sin
PESERTA
28/06/1921
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,783 0001601857304 1901032405790003
5289
Ming Ce
PESERTA
24/05/1979
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,784 0001601857315 1901034801900003
5289
Tresia
ISTRI
08/01/1990
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,785 0001601857326 1901034508110001
5289
Juli Merlyana Then
ANAK
05/08/2011
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,786 0001601857337 1901030511600002
5292
Jumakir
PESERTA
05/11/1960
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,787 0001601857348 1901035507710003
5296
Kim Liong
PESERTA
15/07/1971
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,788 0001601857359 1901031407260005
5298
Romlah
PESERTA
05/04/1949
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,789 0001601857361 1901035706690001
5298
Hanina
ANAK
17/05/1969
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,790 0001601857372 1901037006670009
5298
Hindoviva
ANAK
30/06/1967
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,791 0001601857383 1901032605920001
5298
Kristian hadi Saputra
TAMBAHAN
26/05/1992
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,792 0001601857394 1901031010720003
5302
Ahmad Helmi
PESERTA
10/10/1972
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 252 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,793 0001601857405 1901035411740001
5302
Susalmah
ISTRI
14/11/1974
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,794 0001601857416 1901035711020001
5302
Lusi hermawati
ANAK
17/11/2002
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,795 0001601857427 1901034406060001
5302
Junita Dwi lestari
ANAK
04/06/2006
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,796 0001601857438 1901034607080002
5302
Karina pratiwi
ANAK
06/07/2008
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,797 0001601857449 1901031807140002
5302
Muhammad Azam Al Amin
ANAK
18/07/2014
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,798 0001601857451 1901032904720001
5308
Suwandi
PESERTA
29/04/1972
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,799 0001601857462 1901034304850002
5308
Lilis Susanti
ISTRI
03/04/1985
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,800 0001601857473 1901036301020001
5308
Sulistiawati
ANAK
23/01/2002
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,801 0001601857484 1901034707090001
5308
Liza Julianti
ANAK
07/07/2009
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,802 0001601857495 1901031001870002
5312
Maman Efendi
PESERTA
10/01/1987
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,803 0001601857506 1901035009700003
5312
Cik Inem
ISTRI
10/09/1970
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,804 0001601857517 1901032908910001
5312
Ichsan Hidayat
ANAK
29/08/1991
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,805 0001601857528 1901035004000002
5312
Vellya Apriliani
ANAK
10/04/2000
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,806 0001601857539 1901030508120002
5316
Firan Ramadhan
PESERTA
05/08/2012
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,807 0001601857541 1901030107570009
5317
Mansyur
PESERTA
01/07/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,808 0001601857552 1901030507480001
5318
Rusli Juki
PESERTA
05/07/1948
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,809 0001601857563 1901035111540002
5318
Norita
ISTRI
11/11/1954
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,810 0001601857574 1901030103850002
5318
Hairul Effendi
ANAK
01/03/1985
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,811 0001601857585 1901033011870002
5318
Sandi Candra
ANAK
30/11/1987
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,812 0001601857596 1901031402720001
5322
Riduan
PESERTA
14/02/1972
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,813 0001601857607 1901036403790001
5322
Nur Srihelmala
ISTRI
24/03/1979
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,814 0001601857618 1901034609020001
5322
Wulanda margeanda
ANAK
06/09/2002
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,815 0001601857629 1901034310070001
5322
Windi Fina Tartika
ANAK
03/10/2007
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 253 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,816 0001601857631 1901036808510002
5322
Bainah
TAMBAHAN
28/08/1951
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,817 0001601857642 1901037010850001
5327
Rinni Meisyarian
PESERTA
30/10/1985
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,818 0001601857653 1901030211010001
5327
Richo Vikiranda
ANAK
02/11/2001
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,819 0001601857664 1901031004070001
5327
Rival Virando
ANAK
10/04/2007
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,820 0001601857675 1901031705770001
5330
Joni
PESERTA
17/05/1977
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,821 0001601857686 1901034508800001
5330
Sumarni
ISTRI
05/08/1980
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,822 0001601857697 1901034412010004
5330
Azhara Surviani
ANAK
04/12/2001
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,823 0001601857708 1901030705050003
5330
Azlan Gandari
ANAK
07/05/2005
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,824 0001601857719 1901031110650001
5334
Mustafa
PESERTA
11/10/1965
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,825 0001601857721 1901035604620001
5334
Silsawati
ISTRI
16/04/1962
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,826 0001601857732 1901031611890001
5334
Adnan Khassoghy
ANAK
16/11/1989
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,827 0001601857743 1901035701920004
5334
Mery Janiasty Pratiwi
ANAK
17/01/1992
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,828 0001601857754 1901030904950002
5334
Ricky Reynaldi Putra
ANAK
09/04/1995
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,829 0001601857765 1901032601710002
5339
Suherwan
PESERTA
26/01/1971
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,830 0001601857776 1901036401780001
5339
Rika
ISTRI
24/01/1978
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,831 0001601857787 1901034107990024
5339
Tira kirana
ANAK
01/07/1999
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,832 0001601857798 1901031010020005
5339
Reren Purnama
ANAK
10/10/2002
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,833 0001601857809 1901035407460001
5339
Hazizah
TAMBAHAN
14/07/1946
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,834 0001601857811 1901034107380006
5344
Zamani
PESERTA
01/07/1938
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,835 0001601857822 1901034712590001
5345
Soleha
PESERTA
07/12/1959
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,836 0001601857833 1901031607720001
5346
Andul Muis
PESERTA
16/07/1972
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,837 0001601857844 1901031608900002
5346
Anita
ISTRI
15/06/1980
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,838 0001601857855 1901032104970002
5346
Riki Wahyu Ilahi
ANAK
21/04/1997
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 254 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,839 0001601857866 1901030909000004
5346
Abi Mayu
ANAK
09/09/2000
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,840 0001601857877 1901033003520001
5350
Tamrin
PESERTA
30/03/1952
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,841 0001601857888 1901035509570001
5350
Aida
ISTRI
15/09/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,842 0001601857899 1901031703830001
5350
Andi
ANAK
17/03/1983
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,843 0001601857901 1901032009870002
5350
Jupri yadi
ANAK
20/09/1987
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,844 0001601857912 1901036311560001
5354
Sumini
PESERTA
23/11/1956
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,845 0001601857923 1901031804880003
5354
Rully Saputra
ANAK
18/04/1988
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,846 0001601857934 1901034107520024
5356
Usmalia
PESERTA
01/07/1953
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,847 0001601857945 1901030107570010
5357
Cik aras
PESERTA
11/11/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,848 0001601857956 1901031109870003
5358
Suwandi
PESERTA
11/09/1987
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,849 0001601857967 1901034702900005
5358
Siti lailah
ISTRI
07/02/1990
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,850 0001601857978 1901035501070002
5358
Julia
ANAK
16/01/2007
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,851 0001601857989 1901036110090001
5358
Aliya Setya
ANAK
21/10/2009
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,852 0001601857991 1901030205530001
5362
Hasan Sutanta
PESERTA
02/05/1953
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,853 0001601858002 1901034906680001
5362
Siti Aisah
ISTRI
09/06/1968
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,854 0001601858013 1901030502890001
5362
Agung Fauziana
ANAK
05/02/1989
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,855 0001601858024 1901031509950002
5362
Indra Hardiansyah
ANAK
15/09/1995
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,856 0001601858035 1901030107580030
5366
Ahmad Mustopa
PESERTA
01/07/1958
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,857 0001601858046 1901037112570003
5366
Hadinah
ISTRI
31/12/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,858 0001601858057 1901030508820001
5368
Hendri
PESERTA
05/08/1982
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,859 0001601858068 1901034803880001
5368
Susilawati
ISTRI
08/03/1988
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,860 0001601858079 1901034112060001
5368
Silvana Destalita
ANAK
01/12/2006
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,861 0001601858081 1901035511620001
5371
Hj.Niliwati
PESERTA
15/11/1962
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 255 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,862 0001601858092 1901035005990006
5371
Vergia Yunanita Fradilah
ANAK
10/05/1999
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,863 0001601858103 1901036808590002
5373
Maryama
PESERTA
28/08/1959
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,864 0001601858114 1901031503970003
5373
Beri Akbar
ANAK
15/03/1997
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,865 0001601858125 1901035105540002
5375
Cik Tum
PESERTA
11/05/1954
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,866 0001601858136 1901035404240001
5375
Cik Na
ANAK
14/04/1924
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,867 0001601858147 1901030112690001
5377
Suwandi A.k
PESERTA
01/12/1969
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,868 0001601858158 1901036203710001
5377
Nellawati
ISTRI
22/03/1971
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,869 0001601858169 1901035007010001
5377
Helda Tri Juliana
ANAK
15/07/2001
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,870 0001601858171 1901032807760002
5380
Ucha Patoredi
PESERTA
28/07/1976
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,871 0001601858182 1901036812850002
5380
Desi Natalia
ISTRI
28/12/1985
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,872 0001601858193 1901032703070003
5380
Imam Maulana
ANAK
27/03/2007
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,873 0001601858204 1901034908120002
5380
Farrah Ramadhani
ANAK
09/08/2012
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,874 0001601858215 1901030304770004
5384
Yuhani
PESERTA
03/04/1977
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,875 0001601858226 1901036507720005
5384
Yuliza
ISTRI
25/07/1973
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,876 0001601858237 1901032101990002
5384
Gio Vanni Erisandy
ANAK
21/01/1999
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,877 0001601858248 1901035010000002
5384
Olga Oktavirenti
ANAK
10/10/2000
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,878 0001601858259 1901030201130001
5384
Gebril Nikozahanky
ANAK
02/01/2013
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,879 0001601858261 1901032502750002
5389
Herri
PESERTA
25/02/1975
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,880 0001601858272 1901035001820003
5389
Neneng
ISTRI
10/01/1982
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,881 0001601858283 1901035707040002
5389
Tere Claudia
ANAK
17/01/2004
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,882 0001601858294 1901034609100001
5389
Adrin Rahmadani
ANAK
06/09/2010
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,883 0001601858305 1901031112770001
5393
Subir
PESERTA
11/12/1977
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,884 0001601858316 1901034912810001
5393
Novirawaty
ISTRI
09/11/1981
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 256 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,885 0001601858327 1901034912030001
5393
Fivrida Desliyanti
ANAK
09/12/2003
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,886 0001601858338 1901031609090001
5393
David Sabriano
ANAK
16/09/2009
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,887 0001601858349 1901030203440002
5397
Hasyim.AR
PESERTA
02/03/1944
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,888 0001601858351 1901035204500001
5397
Amnah
ISTRI
12/04/1979
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,889 0001601858362 1901031503320001
5399
Rusik
PESERTA
15/03/1932
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,890 0001601858373 1901031507570001
5400
Sarnudin
PESERTA
15/07/1957
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,891 0001601858384 1901034305500001
5401
Sumi
PESERTA
03/05/1950
BATURUSA
01/01/2015
AKTIF
19,225
30/12/2014
5,892 0001601858395 1901041201880005
5403
Muhammad Adha
PESERTA
01/12/1988
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,893 0001601858406 1901042707380001
5404
Kardi Murod
PESERTA
27/07/1938
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,894 0001601858417 1901040107380001
5405
hambali
PESERTA
07/01/1938
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,895 0001601858428 1901044107250009
5406
nursiyah
PESERTA
07/01/1925
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,896 0001601858439 1901040803710002
5407
gunawan
PESERTA
03/08/1971
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,897 0001601858441 1901044707610056
5408
Saryati
PESERTA
01/07/1961
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,898 0001601858452 1901044609710001
5409
Sopiah
PESERTA
06/09/1971
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,899 0001601858463 1901045503510001
5410
Hasanah
PESERTA
15/03/1951
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,900 0001601858474 1901044107560056
5411
Jumi'ah
PESERTA
01/07/1956
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,901 0001601858485 1901045208560001
5412
Asiah
PESERTA
12/08/1956
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,902 0001601858496 1901045670850001
5413
Hosiah
PESERTA
16/08/1950
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,903 0001601858507 1901042708830003
5414
Ari Gustiawan
PESERTA
27/08/1983
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,904 0001601858518 1901040107670122
5415
Ismail
PESERTA
01/07/1967
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,905 0001601858529 1901044107630081
5417
Hasanah
PESERTA
01/07/1963
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,906 0001601858531 1901045202940002
5417
SRI HERLINA
ANAK
02/12/1994
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,907 0001601858542 1901041712680001
5419
Romdani
PESERTA
17/10/1968
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 257 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,908 0001601858553 1901041107280006
5420
Selman
PESERTA
01/07/1928
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,909 0001601858564 1901041107880001
5421
Oktarimi
PESERTA
01/10/1978
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,910 0001601858575 1901044107530069
5422
Maryam
PESERTA
01/07/1953
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,911 0001601858586 1901040906660001
5424
M. Hoiri
PESERTA
09/06/1966
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,912 0001601858597 1901044107500046
5425
Rosnah
PESERTA
01/07/1950
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,913 0001601858608 1901044104560003
5426
Asmani
PESERTA
01/04/1956
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,914 0001601858619 1901040908620004
5427
Zulkipli
PESERTA
09/08/1962
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,915 0001601858621 1901040107650079
5428
Albet Toni
PESERTA
01/07/1965
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,916 0001601858632 1901044203840003
5429
Yurina Isnaini
PESERTA
02/03/1984
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,917 0001601858643 1901040107500058
5430
Abdullah
PESERTA
01/07/1950
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,918 0001601858654 1901042008540601
5431
Sopiyan
PESERTA
20/08/1959
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,919 0001601858665 1901040107470004
5432
Saldi Mukel
PESERTA
16/01/1948
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,920 0001601858676 1901044107470062
5433
Halimah
PESERTA
01/07/1947
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,921 0001601858687 1901042405800001
5434
Romza
PESERTA
24/05/1980
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,922 0001601858698 1901041511720001
5435
Supri Kurnadi
PESERTA
15/11/1972
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,923 0001601858709 1901042104650003
5436
Suib
PESERTA
21/04/1965
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,924 0001601858711 1901044107540061
5437
Halimah
PESERTA
01/07/1954
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,925 0001601858722 1901041507660001
5438
Mas'ud
PESERTA
15/07/1966
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,926 0001601858733 1901040107510001
5439
Jakpar
PESERTA
01/07/1951
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,927 0001601858744 1901040107680089
5440
Yurdani
PESERTA
01/07/1960
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,928 0001601858755 1901044506750003
5441
Sumaroti
PESERTA
05/06/1975
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,929 0001601858766 1901040107640088
5442
Ibnu
PESERTA
01/07/1964
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,930 0001601858777 1901042908830002
5443
M. Isno
PESERTA
29/08/1983
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 258 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,931 0001601858788 1901040711510001
5444
SUPARDI
PESERTA
07/11/1951
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,932 0001601858799 1901040703790001
5444
ARSIL
ANAK
07/03/1979
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,933 0001601858801 1901040704800003
5444
DAGOL
ANAK
07/04/1980
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,934 0001601858812 1901040703810001
5444
KANDAR
ANAK
07/04/1981
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,935 0001601858823 1901040706800002
5448
LUKMAN
PESERTA
07/06/1980
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,936 0001601858834 1901044709840001
5448
TURA
ISTRI
07/09/1984
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,937 0001601858845 1901044402060001
5448
SITI PATIMAH
ANAK
04/02/2006
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,938 0001601858856 1901046407080001
5448
MIA
ANAK
24/07/2008
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,939 0001601858867 1901044705470001
5452
SEBIAH
PESERTA
07/05/1947
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,940 0001601858878 1901045907370007
5453
ASIAH
PESERTA
19/07/1937
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,941 0001601858889 1901041201570001
5454
BUJUNG
PESERTA
12/01/1957
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,942 0001601858891 1901045607600002
5454
NATI
ISTRI
16/07/1960
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,943 0001601858902 1901044708550001
5456
JUMIAH
PESERTA
07/08/1955
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,944 0001601858913 1901042010910001
5456
M.ALI
ANAK
20/10/1991
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,945 0001601858924 1901046007470001
5458
PIL
PESERTA
20/07/1947
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,946 0001601858935 1901042807720001
5458
DAGOL
ANAK
28/07/1972
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,947 0001601858946 1901040307470001
5460
SAMSU
PESERTA
03/07/1947
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,948 0001601858957 1901040406860003
5460
ASRUL
ANAK
04/06/1986
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,949 0001601858968 1901044101890008
5460
SAVINTA SANTI
ANAK
01/01/1989
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,950 0001601858979 1901046611070002
5460
RIKA KARMILA
ANAK
26/11/2007
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,951 0001601858981 1901043112550006
5464
ROMLI
PESERTA
31/12/1955
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,952 0001601858992 1901045506520001
5464
SAROK
ISTRI
15/06/1952
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,953 0001601859003 1901042102960001
5464
TAMRIN
ANAK
21/02/1996
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 259 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,954 0001601859014 1901044311490001
5467
ASIDAH
PESERTA
03/11/1949
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,955 0001601859025 1901041507870003
5467
ROHIM
ANAK
15/07/1987
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,956 0001601859036 1901046909010001
5467
NUR HASANAH
ANAK
29/09/2001
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,957 0001601859047 1901040311820008
5470
ANDRI
PESERTA
03/11/1982
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,958 0001601859058 1901044107880117
5470
SUMITRI
ISTRI
01/07/1988
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,959 0001601859069 1901044707090002
5470
ELING SALSA
WIJAYANTI
ANAK
07/07/2009
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,960 0001601859071 1901042503130002
5470
KELVIN WIJAYA
ANAK
25/03/2013
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,961 0001601859082 1971021010820000
5474
JERFI YANTO
PESERTA
10/10/1982
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,962 0001601859093 1901045206830003
5474
ARPAH
ISTRI
12/06/1983
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,963 0001601859104 1901046705050001
5474
MILI
ANAK
27/05/2005
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,964 0001601859115 1901042701760001
5479
SANUBI
PESERTA
27/01/1976
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,965 0001601859126 1901042211970002
5479
ISYA RUDIN
ANAK
22/11/1997
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,966 0001601859137 1901042611990005
5479
GALIH KASIWIN
ANAK
26/11/1999
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,967 0001601859148 1901045602010003
5479
DINI
ANAK
16/02/2001
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,968 0001601859159 1901041610040002
5479
KARIDET
ANAK
16/10/2004
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,969 0001601859161 1901041404080003
5479
DONI
ANAK
14/04/2008
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,970 0001601859172 1901040107590064
5485
SUKUR
PESERTA
01/07/1959
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,971 0001601859183 1901045504830002
5485
HASINAH
ISTRI
15/04/1963
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,972 0001601859194 1901041607840003
5485
SUPRIYADI
ANAK
16/07/1984
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,973 0001601859205 1901040102880001
5485
MERIYANTO
ANAK
01/02/1988
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,974 0001601859216 1901040507990003
5485
ISDAN
ANAK
05/07/1999
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,975 0001601859227 1901044701690022
5490
NOI
PESERTA
07/01/1969
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,976 0001601859238 1901040508900004
5490
DANI
ANAK
05/08/1990
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 260 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
5,977 0001601859249 1901041501980002
5490
BASRI
ANAK
15/01/1998
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,978 0001601859251 1901042405810002
5494
RUDI
PESERTA
24/05/1981
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,979 0001601859262 1901045708830001
5494
ERNA
ISTRI
17/08/1983
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,980 0001601859273 1901044504020002
5494
MAIMUNAH
ANAK
05/04/2002
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,981 0001601859284 1901042506660001
5497
BUJANG ASRI
PESERTA
25/06/1966
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,982 0001601859295 1901045010770009
5497
SAUDAH
ISTRI
10/10/1977
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,983 0001601859306 1901042404040003
5497
ARDIANSYAH
ANAK
24/04/2004
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,984 0001601859317 1901045402100002
5497
AZIZAH
ANAK
14/02/2010
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,985 0001601859328 1901044603890004
5501
SOLIHIN
PESERTA
10/08/1986
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,986 0001601859339 1901044603890000
5501
MARYANI
ISTRI
06/03/1989
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,987 0001601859341 1901040707070004
5501
MUSLIMIN
ANAK
07/07/2007
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,988 0001601859352 1901044712100003
5501
MELISA
ANAK
07/12/2010
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,989 0001601859363 1901042005120002
5501
SIRIHAN
ANAK
20/05/2012
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,990 0001601859374 1901040306920002
5506
RANDI
PESERTA
03/06/1992
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,991 0001601859385 1901044302940002
5506
ASNAH
ISTRI
03/02/1994
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,992 0001601859396 1901042906120001
5506
RENO ALFAHRI
ANAK
29/06/2012
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,993 0001601859407 1901043012620001
5506
MARZUKI
ANAK
30/12/1962
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,994 0001601859418 1901044107600001
5510
JAMILAH
PESERTA
01/07/1960
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,995 0001601859429 1901041808850001
5510
YANI
ANAK
18/08/1985
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,996 0001601859431 1901040107880001
5513
MAWAR
PESERTA
01/07/1988
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,997 0001601859442 1901041507850004
5514
DOLARI
PESERTA
15/07/1985
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,998 0001601859453 1901044107880118
5514
JUMILAH
ISTRI
01/07/1988
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
5,999 0001601859464 1901041507060002
5514
JOHAN
ANAK
15/07/2006
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 261 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,000 0001601859475 1901046008830003
5517
ROPIAH
PESERTA
20/08/1983
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,001 0001601859486 1901040201050004
5517
AHMAD DHANI
ANAK
02/01/2005
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,002 0001601859497 1901042811050002
5517
AHMAD TARMIZI
ANAK
28/11/2005
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,003 0001601859508 1901044107660075
5520
MIHO
PESERTA
01/07/1966
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,004 0001601859519 1901040510880003
5520
PIKAL
ANAK
05/10/1988
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,005 0001601859521 1901042406930002
5520
PAIDI
ANAK
24/06/1993
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,006 0001601859532 1901042507980001
5520
ROMADON
ANAK
25/07/1998
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,007 0001601859543 1901041708990003
5520
AGUS RIANTO
ANAK
17/08/1999
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,008 0001601859554 1901040405300001
5525
ALI IBRAHIM
PESERTA
04/05/1930
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,009 0001601859565 1901044803470001
5525
NORIAH
ISTRI
08/03/1947
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,010 0001601859576 1901041709780001
5525
NASRUN
ANAK
17/09/1978
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,011 0001601859587 1901042204760001
5525
ZULKIPLI
ANAK
22/04/1976
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,012 0001601859598 1901040607780002
5529
RIYANTO
PESERTA
06/07/1978
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,013 0001601859609 1901044107770093
5529
ROMIYAH
ISTRI
01/07/1977
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,014 0001601859611 1901045309030003
5529
MAHARANI
ANAK
13/09/2003
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,015 0001601859622 1901042410090001
5529
DEDEN FAHREZI
ANAK
24/10/2009
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,016 0001601859633 1901040705690001
5533
AGUS CIK
PESERTA
07/05/1969
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,017 0001601859644 1901046807690003
5533
DAIMA
ISTRI
28/07/1969
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,018 0001601859655 1901040402960001
5533
LADIMAN
ANAK
04/02/1996
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,019 0001601859666 1901045009980001
5533
SELINA
ANAK
10/09/1998
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,020 0001601859677 1901044412020002
5533
DEA SAPITRI
ANAK
04/12/2002
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,021 0001601859688 1901044401090002
5533
ASTRI DAMAYANTI
ANAK
04/01/2009
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,022 0001601859699 1901040107680074
5539
BULIS
PESERTA
01/07/1968
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 262 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,023 0001601859701 1901044107880116
5539
ROMINI
ISTRI
01/07/1988
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,024 0001601859712 1901045903120001
5539
BUNGA
ANAK
19/03/2012
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,025 0001601859723 1901046604050004
5539
INTAN NURAINI
ANAK
26/04/2005
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,026 0001601859734 1901044112540001
5543
HOMSIAH
PESERTA
01/12/1954
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,027 0001601859745 1901040910930002
5543
SAPARUDIN
ANAK
09/10/1993
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,028 0001601859756 1901040107520076
5545
SUDIRMAN
PESERTA
01/07/1952
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,029 0001601859767 1901044107390024
5545
AMOI
TAMBAHAN
01/07/1939
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,030 0001601859778 1901040305680003
5547
BAHERUDIN
PESERTA
03/05/1968
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,031 0001601859789 1901044005720005
5547
SUPIYANI
ISTRI
06/05/1972
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,032 0001601859791 1901040202900007
5547
RIKI ULANDARI
ANAK
02/02/1990
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,033 0001601859802 1901042509980004
5547
REZA YOGANTARA
ANAK
25/09/1998
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,034 0001601859813 1901042905020004
5547
PUTRA MUHAMMAD
HIDAYAT
ANAK
29/05/2002
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,035 0001601859824 1901046007670002
5552
SAKYAM
PESERTA
20/07/1967
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,036 0001601859835 1901040710950001
5552
TOMI ALI
ANAK
01/07/1995
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,037 0001601859846 1901041212930004
5552
RIKI
ANAK
16/08/1993
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,038 0001601859857 1901044701930002
5552
TOIBAH
ANAK
01/07/1997
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,039 0001601859868 1901046709550001
5552
UDIN
TAMBAHAN
27/09/1955
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,040 0001601859879 1901044507970069
5552
SANTI
TAMBAHAN
05/07/1997
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,041 0001601859881 1901040612340001
5558
ABIR KUT
PESERTA
06/12/1934
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,042 0001601859892 1901044609820001
5558
SURYAH
ANAK
06/09/1982
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,043 0001601859903 1901041711840002
5558
SUGIANTO
ANAK
17/11/1984
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,044 0001601859914 1901042003700003
5561
SUPRI
PESERTA
20/03/1970
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,045 0001601859925 1901045508830002
5561
ROM
ISTRI
15/08/1983
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 263 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,046 0001601859936 1901041903060001
5561
DANA AFANDI
ANAK
19/03/2006
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,047 0001601859947 1901046501080002
5561
JAMILAH
ANAK
25/01/2008
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,048 0001601859958 1901046605120002
5561
KHADIJAH
ANAK
26/05/2012
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,049 0001601859969 1901041503570001
5566
SIRIH
PESERTA
15/03/1957
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,050 0001601859971 1901044107680108
5566
SINA
ISTRI
01/07/1968
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,051 0001601859982 1901045207040008
5566
SILVIA
ANAK
12/07/2004
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,052 0001601859993 1901041112470001
5569
AHMAD
PESERTA
11/12/1947
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,053 0001601860004 1901044107540040
5569
RUBI
ISTRI
01/07/1954
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,054 0001601860015 1901041509320001
5571
DERUS
PESERTA
15/09/1932
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,055 0001601860026 1901040706790001
5571
MAHRUP
ANAK
07/06/1979
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,056 0001601860037 1901041205870002
5571
HARMOKO
ANAK
12/05/1987
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,057 0001601860048 1901041411950002
5571
BURLIAN
ANAK
14/11/1995
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,058 0001601860059 1901044907970001
5571
NURHAYATI
ANAK
19/07/1997
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,059 0001601860061 1901040204990001
5571
RUMA
ANAK
02/04/1999
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,060 0001601860072 1901044204660001
5577
ROSNAH
PESERTA
02/04/1968
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,061 0001601860083 1901044306940002
5577
PARIDA
ANAK
03/06/1994
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,062 0001601860094 1901041706950004
5577
MUSA
ANAK
17/06/1996
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,063 0001601860105 1901040304550001
5580
CONG
PESERTA
03/04/1955
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,064 0001601860116 1901045006570001
5580
ZURIAH
ISTRI
10/06/1957
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,065 0001601860127 1901041104830006
5580
ANDI
ANAK
11/04/1983
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,066 0001601860138 1901042911860001
5580
ENDI
ANAK
29/11/1986
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,067 0001601860149 1901041805930001
5580
MUHAMMAD LIBAN
ANAK
18/05/1993
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,068 0001601860151 1901042906580001
5585
SULKATI
PESERTA
29/06/1958
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 264 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,069 0001601860162 1901044511670001
5585
JIRAH
ISTRI
05/11/1967
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,070 0001601860173 1901040906990002
5585
TANA
ANAK
09/06/1999
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,071 0001601860184 1901045107010001
5585
AIDAH
ANAK
11/07/2001
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,072 0001601860195 1901045901630001
5589
NANI
PESERTA
19/01/1963
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,073 0001601860206 1901041206830001
5589
YANTO
ANAK
12/06/1983
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,074 0001601860217 1901043012880001
5589
SUKANDI
ANAK
30/12/1988
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,075 0001601860228 1901045206890003
5589
SUMARIAH
ANAK
12/06/1989
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,076 0001601860239 1901041601930001
5589
SUMANTRI
ANAK
16/01/1993
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,077 0001601860241 1901045112980001
5589
NURJANAH
ANAK
11/12/1998
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,078 0001601860252 1901046810020002
5589
NURUL HIKMAH
ANAK
28/10/2002
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,079 0001601860263 1901042707050002
5589
MUHAMMAD
NAWAWI
ANAK
27/07/2005
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,080 0001601860274 1901042504760003
5597
GUN
PESERTA
25/04/1976
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,081 0001601860285 1901046005010003
5597
ELA ISNANI
ANAK
20/05/2001
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,082 0001601860296 1901041209030001
5597
FAUZAN
ANAK
12/09/2003
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,083 0001601860307 1901045009030001
5597
SANTI
ANAK
10/09/2005
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,084 0001601860318 1901047112320001
5602
CANIN
PESERTA
31/12/1932
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,085 0001601860329 1901046302450001
5603
MARIAH
PESERTA
23/02/1945
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,086 0001601860331 1901045309830001
5603
BAITI
ANAK
13/06/1982
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,087 0001601860342 1901046007850001
5603
SUNARTI
ANAK
20/07/1985
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,088 0001601860353 1901047003570001
5603
AMANAH
TAMBAHAN
30/03/1957
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,089 0001601860364 1901044107560087
5607
HOLIJA
PESERTA
01/07/1956
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,090 0001601860375 1901040107760059
5607
SARUNI
ANAK
01/07/1976
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,091 0001601860386 1901041803880004
5607
JUMADI
ANAK
18/03/1988
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 265 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,092 0001601860397 1901046304900001
5607
SUMIYATI
ANAK
23/04/1990
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,093 0001601860408 1901046701950003
5607
PARINA
ANAK
27/01/1995
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,094 0001601860419 1901044407980003
5607
SARNAWATI
ANAK
04/07/1998
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,095 0001601860421 1901044107600119
5613
JURA
PESERTA
01/07/1960
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,096 0001601860432 1901044406970007
5613
HOLA LIDIYAH
ANAK
04/06/1997
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,097 0001601860443 1901040107420032
5615
JASAN
PESERTA
01/07/1942
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,098 0001601860454 1901040107820083
5615
ZULPIKAR
ANAK
01/07/1982
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,099 0001601860465 1901047112740000
5617
NUR HAZIZA
PESERTA
31/12/1974
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,100 0001601860476 1901042705990002
5617
ILHAM ALHALIK
ANAK
27/05/1999
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,101 0001601860487 1901042802010004
5617
MASRIL MEHENDRA
ANAK
28/02/2001
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,102 0001601860498 1901046901030004
5617
SUSI MUSDALIPAH
ANAK
29/01/2003
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,103 0001601860509 1901042603040001
5617
MUHAMMAD
ALDINATA
ANAK
26/03/2004
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,104 0001601860511 1901042907060003
5617
MUHAMMAD
IMAM ALROBI
ANAK
29/07/2006
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,105 0001601860522 1901044401470001
5623
TUTI
PESERTA
05/01/1947
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,106 0001601860533 1901040503690004
5623
IWAN
ANAK
05/03/1969
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,107 0001601860544 1901044107380024
5625
ZAWAJIR
PESERTA
01/07/1938
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,108 0001601860555 1901041904800001
5626
IWANDI
PESERTA
19/04/1980
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,109 0001601860566 1901046005780001
5626
ACIT
ISTRI
20/05/1978
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,110 0001601860577 1901044107010001
5626
ROAI
ANAK
01/07/2001
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,111 0001601860588 1901042003780005
5629
SUPLI
PESERTA
20/03/1978
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,112 0001601860599 1901045504820003
5629
SURYAN
ISTRI
15/04/1982
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,113 0001601860601 1901040707030002
5629
PAISAL
ANAK
07/07/2003
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 266 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,114 0001601860612 1901042706050001
5629
PIRDAN
ANAK
27/06/2005
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,115 0001601860623 1901044701130002
5629
NISA
ANAK
07/01/2013
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,116 0001601860634 1901044107690066
5634
SULUSIAH
PESERTA
01/07/1969
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,117 0001601860645 1901040101850004
5635
MUHAMMAD JUMALI
PESERTA
01/01/1985
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,118 0001601860656 1903056009810001
5635
MARIYANI
ISTRI
20/09/1991
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,119 0001601860667 1901042205130001
5635
AHMAD SYUKRY
ANAK
22/05/2013
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,120 0001601860678 1903051707060002
5635
MUHAMMAD TAMIR
ANAK
17/07/2006
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,121 0001601860689 1901040107340022
5639
ROMLI
PESERTA
01/07/1934
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,122 0001601860691 1901045010740004
5639
ROSNAH
TAMBAHAN
10/10/1974
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,123 0001601860702 1901045604080004
5639
ELIS
TAMBAHAN
16/04/2008
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,124 0001601860713 1901040101750002
5642
BUJANG SATU
PESERTA
01/01/1975
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,125 0001601860724 1901044107800113
5642
ILHAM
ISTRI
01/07/1980
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,126 0001601860735 1901040902090001
5642
NAFIS
ANAK
09/02/2008
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,127 0001601860746 1901040705080004
5642
TAMRIN
ANAK
09/07/2008
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,128 0001601860757 1901045203100002
5642
MUHAMMAD HABIBI
ANAK
12/03/2010
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,129 0001601860768 1901040902120002
5642
MUHAMMAD HOLBI
ANAK
09/02/2012
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,130 0001601860779 1901045511130002
5642
KASIH AFTA
ANAK
15/11/2013
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,131 0001601860781 1901040507750005
5649
PAIMIN
PESERTA
05/07/1975
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,132 0001601860792 1901045002830001
5649
MASRIYAH
ISTRI
10/02/1983
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,133 0001601860803 1901045501050001
5649
FARAMITA
ANAK
15/01/2005
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,134 0001601860814 1901042812090002
5649
MUHAMMAD ARIL
ANAK
28/12/2009
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,135 0001601860825 1901040502120001
5649
MUHAMMAD MAULANA
ANAK
05/02/2012
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,136 0001601860836 1901044107820120
5654
AINUN
PESERTA
01/07/1982
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 267 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,137 0001601860847 1901045707060006
5654
DINDA
ANAK
17/07/2006
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,138 0001601860858 1901041104860002
5656
INDRA SUMAYADI
PESERTA
11/04/1986
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,139 0001601860869 1901044107820088
5656
SUNAITI
ISTRI
01/07/1982
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,140 0001601860871 1901046902080001
5656
INDRI PEBIYANTI
ANAK
29/02/2008
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,141 0001601860882 1901041611120001
5656
MUHAMMAD SUPRIYADI
ANAK
16/11/2012
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,142 0001601860893 1901040107540032
5660
BASRI
PESERTA
01/07/1954
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,143 0001601860904 1901044107530035
5660
SIRAH
ISTRI
01/07/1953
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,144 0001601860915 1901040809940002
5660
TURKI
ANAK
08/09/1994
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,145 0001601860926 1901040107880122
5663
KULI
PESERTA
01/07/1988
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,146 0001601860937 1901045703900006
5663
YUNINGSIH
ISTRI
17/03/1990
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,147 0001601860948 1901047110100001
5663
PUTRI AULIA PRATIWI
ANAK
31/10/2010
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,148 0001601860959 1901040704520002
5666
SARMANO
PESERTA
07/04/1952
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,149 0001601860961 1901041506800002
5666
SARBANI
ANAK
15/06/1980
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,150 0001601860972 1901044411820003
5666
SILA
ANAK
04/11/1982
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,151 0001601860983 1901042211860002
5666
ISMAIL
ANAK
22/11/1986
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,152 0001601860994 1901046903000002
5666
SULASTRI
ANAK
29/03/2000
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,153 0001601861005 1901040607560001
5671
SAHIR
PESERTA
06/07/1956
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,154 0001601861016 1901044508760002
5671
SUMAINI
ISTRI
05/08/1976
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,155 0001601861027 1901044301980002
5671
MIBTAHUL JANNAH
ANAK
03/01/1998
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,156 0001601861038 1901041004990001
5671
SULAIMAN
ANAK
10/04/1999
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,157 0001601861049 1901041209010001
5671
SUMANTRI
ANAK
12/09/2001
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,158 0001601861051 1901045804700001
5676
NANI
PESERTA
18/04/1970
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,159 0001601861062 1901042108000004
5676
ANDARI
ANAK
21/08/2000
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 268 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,160 0001601861073 1901040107620065
5678
ULIT
PESERTA
01/07/1962
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,161 0001601861084 1901044507800002
5678
SUNA
ISTRI
05/07/1980
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,162 0001601861095 1901040107050049
5678
PRIMA
ANAK
01/07/2005
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,163 0001601861106 1901045211100002
5678
AYEN
ANAK
12/11/2010
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,164 0001601861117 1901044107850074
5682
PARINA
PESERTA
08/09/1985
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,165 0001601861128 1901042909030004
5682
WAHYUDI
ANAK
29/09/2003
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,166 0001601861139 1901040204040002
5682
APRILIAN HADI
ANAK
02/04/2004
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,167 0001601861141 1901040107750078
5685
SUKARDI
PESERTA
01/07/1975
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,168 0001601861152 1901045912800001
5685
ARSINA
ISTRI
19/12/1980
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,169 0001601861163 1901045711040001
5685
RASTI KARDILA
ANAK
17/11/2004
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,170 0001601861174 1901044803110002
5685
HALIZA RAHILLIA
ANAK
08/03/2011
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,171 0001601861185 1901040701630021
5689
SAIPUL ANWAR BAHRI
PESERTA
07/01/1963
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,172 0001601861196 1901044701820034
5689
JAMILAH
ISTRI
07/01/1982
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,173 0001601861207 1901041901040002
5689
MUHAMAD SAIDINA ALI
ANAK
19/01/2004
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,174 0001601861218 1901041506100001
5689
JONI ISKANDAR AKBAR
ANAK
15/06/2010
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,175 0001601861229 1901044107970067
5689
DEVI
ANAK
01/07/1997
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,176 0001601861231 1901041605750001
5694
YEPI DONRI
PESERTA
16/05/1975
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,177 0001601861242 1901045105850001
5694
ROSINA RIA
ISTRI
11/05/1985
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,178 0001601861253 1901042505060004
5694
RIYANTO SAPUTRA
ANAK
25/05/2006
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,179 0001601861264 1901040106100002
5694
RENALDI SAPUTRA
ANAK
01/06/2010
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,180 0001601861275 1901040412720003
5698
SATAR
PESERTA
04/11/1972
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,181 0001601861286 1901044708600002
5698
JURA
ISTRI
07/08/1960
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,182 0001601861297 1901040608660001
5700
SANI
PESERTA
06/08/1966
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 269 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,183 0001601861308 1901044907670002
5700
JUMIAH
ISTRI
09/07/1967
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,184 0001601861319 1901040506820001
5700
SULAIMAN
ANAK
05/06/1982
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,185 0001601861321 1901040609900001
5700
BANDRI
ANAK
06/09/1990
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,186 0001601861332 1901044211960001
5700
MULYANA
ANAK
02/11/1996
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,187 0001601861343 1901044311460001
5705
NOK NOH
PESERTA
03/11/1946
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,188 0001601861354 1901041101610001
5705
SUWARNO
ANAK
11/01/1961
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,189 0001601861365 1901044107480056
5707
AINI
PESERTA
01/07/1948
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,190 0001601861376 1901040107820151
5707
MAT
ANAK
01/07/1982
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,191 0001601861387 1901043012820002
5709
ARYADI SUTIKNO
PESERTA
30/12/1982
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,192 0001601861398 1901044107900139
5709
NORNI
ISTRI
01/07/1990
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,193 0001601861409 1901046604070005
5709
ANGGLI
ANAK
26/04/2007
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,194 0001601861411 1901044510120002
5709
CACA
ANAK
05/10/2012
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,195 0001601861422 1901040107580095
5713
KARI
PESERTA
01/07/1958
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,196 0001601861433 1901044107680106
5713
RAHMI
ISTRI
01/07/1968
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,197 0001601861444 1901044107890119
5713
RIA
ANAK
01/07/1989
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,198 0001601861455 1901040107640099
5716
ATRI
PESERTA
01/07/1964
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,199 0001601861466 1901044107690094
5716
ANINA
ISTRI
01/07/1969
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,200 0001601861477 1901045402970002
5716
SONITA
ANAK
14/02/1997
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,201 0001601861488 1901040308000006
5716
ERWANDI
ANAK
03/08/2000
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,202 0001601861499 1901046004040001
5716
SANJANA
ANAK
20/04/2004
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,203 0001601861501 1901042307080001
5716
ANCA RUNATA
ANAK
23/07/2008
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,204 0001601861512 1901042810860002
5716
ZULKIFLI
ANAK
28/10/1986
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,205 0001601861523 1901045607900003
5716
SAFARIDAH
ANAK
16/07/1990
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 270 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,206 0001601861534 1801152607430000
5724
PANIDI
PESERTA
26/07/1943
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,207 0001601861545 1801154308520001
5724
TURIYAH
ISTRI
03/09/1952
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,208 0001601861556 1801152610930001
5724
PRIDIYANTO
ANAK
08/02/1993
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,209 0001601861567 1901041508560001
5727
SAHRUN
PESERTA
15/08/1956
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,210 0001601861578 1901041803880003
5727
ARIF PANDI
ANAK
18/03/1988
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,211 0001601861589 1901042003900001
5727
ANDI
ANAK
20/03/1990
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,212 0001601861591 1901046907950003
5727
SUNI
ANAK
29/07/1995
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,213 0001601861602 1901046107430003
5732
OS
PESERTA
21/07/1943
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,214 0001601861613 1901041103810003
5732
DOMI
ANAK
11/03/1981
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,215 0001601861624 1901041505700005
5733
ZAINI
PESERTA
15/05/1970
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,216 0001601861635 1901044107830082
5733
ZUBAINI
ISTRI
01/07/1983
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,217 0001601861646 1901040207000002
5733
BAIDI
ANAK
02/07/2000
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,218 0001601861657 1901046606060002
5733
TITIN BAHAGIA
ANAK
26/06/2006
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,219 0001601861668 1901040510710001
5737
ARDI
PESERTA
05/10/1971
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,220 0001601861679 1901045004700001
5737
ROMLAH
ISTRI
20/04/1970
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,221 0001601861681 1901045302930001
5737
DESI
ANAK
13/02/1993
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,222 0001601861692 1901040902990001
5737
EFENDI
ANAK
09/02/1999
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,223 0001601861703 1901040505780003
5742
ANHAR
PESERTA
05/05/1978
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,224 0001601861714 1901045512810001
5742
YANTI
ISTRI
15/12/1981
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,225 0001601861725 1901042203030001
5742
RAMADHANI
ANAK
22/03/2001
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,226 0001601861736 1901042201050002
5742
RAMON PERDANA
ANAK
22/01/2005
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,227 0001601861747 1901046515980005
5742
NADA SARI
ANAK
25/05/1998
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,228 0001601861758 1901040805740004
5747
AZHARI
PESERTA
08/05/1974
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 271 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,229 0001601861769 1901046311810003
5747
SURATMI
ISTRI
23/11/1981
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,230 0001601861771 1901042907980001
5747
HARYADI
ANAK
29/07/1998
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,231 0001601861782 1901042809010003
5747
AHMAD JUNAIDI
ANAK
28/09/2001
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,232 0001601861793 1901046707040004
5747
VERRA VERNANDA
ANAK
27/07/2004
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,233 0001601861804 1901044307130001
5747
ALMIRA
ANAK
03/07/2013
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,234 0001601861815 1901040809830001
5753
TULUS WIBOWO
PESERTA
08/09/1983
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,235 0001601861826 1901044107880115
5753
SUMARNI
ISTRI
01/07/1988
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,236 0001601861837 1901042301080001
5753
CANDRA PRATAMA
ESTU WIBOWO
ANAK
23/01/2008
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,237 0001601861848 1901042508770002
5756
ZAMHURI
PESERTA
25/08/1977
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,238 0001601861859 1901044608800001
5756
SAIDA
ISTRI
06/08/1980
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,239 0001601861861 1901045002010004
5756
DEVA OKTAFIA
ANAK
10/02/2001
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,240 0001601861872 1901044708060005
5756
INDAH PURNAMA SARI
ANAK
07/08/2006
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,241 0001601861883 1901040401120002
5756
ALFINDO ARDIANSYAH
ANAK
04/01/2012
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,242 0001601861894 1901040606880004
5761
SUYATNO
PESERTA
06/06/1988
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,243 0001601861905 1901044107870115
5761
TURAIDA
ISTRI
01/07/1987
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,244 0001601861916 1901046705090003
5761
DIANA SAFITRI
ANAK
27/05/2009
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,245 0001601861927 1901040707620001
5764
MANSIR
PESERTA
07/07/1962
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,246 0001601861938 1901045011700003
5764
KARTINI
ISTRI
10/11/1970
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,247 0001601861949 1901041904900002
5764
KAMARUDIN
ANAK
19/04/1990
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,248 0001601861951 1901041611920004
5764
NIKI
ANAK
16/11/1992
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,249 0001601861962 1901040201970002
5764
RINALDI
ANAK
02/01/1997
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,250 0001601861973 1901045107040003
5764
ANJALIKA
ANAK
11/07/2004
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,251 0001601861984 1901040605820004
5770
SAKDON
PESERTA
06/05/1982
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 272 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,252 0001601861995 1901044107820097
5770
SAINA
ISTRI
01/07/1982
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,253 0001601862006 1901040507030005
5770
TOMI HOPRIYADI
ANAK
05/07/2003
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,254 0001601862017 1901041401060002
5770
TORI IRWANDI
ANAK
14/01/2008
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,255 0001601862028 1901045208110001
5770
TANIA SISIL DAHLIA
ANAK
12/08/2011
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,256 0001601862039 1901040104850001
5775
DANI
PESERTA
01/04/1985
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,257 0001601862041 1901044404860002
5775
ROSANA
ISTRI
04/04/1986
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,258 0001601862052 1901046908040001
5775
ALISTRI
ANAK
29/08/2004
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,259 0001601862063 1901045301080001
5775
ANITA
ANAK
13/01/2008
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,260 0001601862074 1901040107780079
5779
ROMI
PESERTA
01/07/1978
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,261 0001601862085 1901044107810099
5779
DIANA
ISTRI
01/07/1981
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,262 0001601862096 1901045006990001
5779
DIAN SARI
ANAK
10/06/1999
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,263 0001601862107 1901042403050002
5779
MARTINI
ANAK
24/03/2005
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,264 0001601862118 1901044606130001
5779
CITRA
ANAK
16/06/2013
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,265 0001601862129 1901042903920001
5784
IBNU KODARI
PESERTA
29/03/1992
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,266 0001601862131 1901045207940002
5784
Siti khodijah
ISTRI
07/12/1994
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,267 0001601862142 1901040210120001
5784
RESKI PAHRIJAL
ANAK
10/02/2012
PETALING
01/01/2015
AKTIF
19,225
30/12/2014
6,268 0001601862153 1901064508470001
5787
SAMSIAH
PESERTA
08/05/1947
BAKAM
01/01/2015
AKTIF
19,225
30/12/2014
6,269 0001601862164 1901060505900003
5788
SARWIN
PESERTA
05/05/1990
BAKAM
01/01/2015
AKTIF
19,225
30/12/2014
6,270 0001601862175 1901065311890001
5788
JUMINI
ISTRI
13/11/1989
BAKAM
01/01/2015
AKTIF
19,225
30/12/2014
6,271 0001601862186 1806064107480006
5790
PIHA
PESERTA
07/01/1948
BAKAM
01/01/2015
AKTIF
19,225
30/12/2014
6,272 0001601862197 1901061108720002
5791
HOTAMAR
PESERTA
08/11/1972
BAKAM
01/01/2015
AKTIF
19,225
30/12/2014
6,273 0001601862208 1901064603740001
5791
DAYANG
ISTRI
03/06/1974
BAKAM
01/01/2015
AKTIF
19,225
30/12/2014
6,274 0001601862219 1901061908950003
5791
DARWIS
ANAK
19/08/1995
BAKAM
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 273 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,275 0001601862221 1901065306970002
5791
DAHLIA
ANAK
13/06/1997
BAKAM
01/01/2015
AKTIF
19,225
30/12/2014
6,276 0001601862232 1901061507990001
5791
DIAN PRIYOGO
ANAK
15/07/1999
BAKAM
01/01/2015
AKTIF
19,225
30/12/2014
6,277 0001601862243 1901020801590002
5796
Sodri
PESERTA
01/08/1959
BELINYU
01/01/2015
AKTIF
19,225
30/12/2014
6,278 0001601862254 1901022480857002
5796
Hatma
ISTRI
08/08/1957
BELINYU
01/01/2015
AKTIF
19,225
30/12/2014
6,279 0001601862265 1901024501060004
5800
FATRISYA ELSANTANA
PESERTA
01/05/2005
BELINYU
01/01/2015
AKTIF
19,225
30/12/2014
6,280 0001601862276 1901016407490001
5803
PHAN A LOE
PESERTA
24/07/1949
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
6,281 0001601862287 1901014410500002
5804
PHAN KIT LOEN
PESERTA
04/10/1950
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
6,282 0001601862298 1901010308920006
5804
EKO GUNADI
ANAK
03/08/1992
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
6,283 0001601862309 1901014712430003
5806
TJHIN A TJIT
PESERTA
07/12/1943
KENANGA
01/01/2015
AKTIF
19,225
30/12/2014
6,284 0001601862715 1901081103490002
4553
Saila
PESERTA
11/03/1949
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
6,285 0001601862726 1901085101590001
4553
Zahmah
TAMBAHAN
11/01/1959
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
6,286 0001601862737 1901081011590001
4555
Rodi
PESERTA
10/11/1959
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
6,287 0001601862748 1901085904600001
4555
Mar
ISTRI
19/04/1960
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
6,288 0001601862759 1901081803840001
4555
Erwan
ANAK
18/03/1984
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
6,289 0001601862761 1901086310920004
4555
Iis dahlia
ANAK
23/10/1992
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
6,290 0001601863018 1901081410850002
4615
Masri
PESERTA
14/10/1984
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
6,291 0001601863029 1901084406910001
4615
Supiana
ISTRI
04/06/1991
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
6,292 0001601863031 1901084304130001
4615
Amelia Pratiwi
ANAK
03/04/2013
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
6,293 0001601863042 1901081503820001
4618
ALBAB
PESERTA
15/03/1982
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
6,294 0001601863053 1901084901840002
4618
MIMI
ISTRI
09/01/1984
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
6,295 0001601863064 1901084406040002
4618
ANDELA
ANAK
04/06/2004
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
6,296 0001601863075 1901081311090001
4618
ALVIAN
ANAK
13/11/2009
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
6,297 0001601863086 1901080104700002
4622
SIRI NAWI ISMAIL
PESERTA
01/04/1970
PUDING BESAR
01/01/2015
AKTIF
19,225
30/12/2014
12/2/15 3:16 PM
Page 274 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,298 0001602720562 1902012105720009
SUPARIYANTO
PESERTA
21/05/1972
TANJUNG PANDAN
01/02/2015
AKTIF
19,225
11/01/2015
6,299 0001602720573 1902015207760011
INTAN
ISTRI
12/07/1967
TANJUNG PANDAN
01/02/2015
AKTIF
19,225
08/01/2015
6,300 0001602720584 1902013101990003
AFKA QORIYANTO
ANAK
31/01/1999
TANJUNG PANDAN
01/02/2015
AKTIF
19,225
08/01/2015
6,301 0001602720595 1902015405030007
IFTINNA NUR INTANI
ANAK
14/05/2003
TANJUNG PANDAN
01/02/2015
AKTIF
19,225
08/01/2015
6,302 0001604269765 1901016208050001
SYIFAUL HUSNA
PESERTA
22/03/2005
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,303 0001604269776 1901014605070001
SALWA ADNA
ANAK
06/05/2007
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,304 0001604269787 1901011707580004
SUHARLI
PESERTA
17/07/1958
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,305 0001604269798 1901016911590002
ARLENI
ISTRI
29/11/1959
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,306 0001604269809 1901015809890005
EKA SARI
PESERTA
18/09/1989
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,307 0001604269811 1901014107900026
DINI AMBARWATI
ANAK
01/07/1990
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,308 0001604269822 1901010107010011
IQBAL
ANAK
01/07/2001
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,309 0001604269833 1901013001570001
SUHARTONO
PESERTA
30/01/1957
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,310 0001604269844 1901015005590002
YANANI
ISTRI
10/05/1959
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,311 0001604269855 1901011009800003
SUPRIYANTO
ANAK
10/09/1980
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,312 0001604269866 1901016206910001
SARI WAHYUNI
ANAK
22/06/1991
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,313 0001604269877 1901016908940003
ASFITA MENTARI
ANAK
29/08/1994
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,314 0001604269888 1901016712750003
13
SYAFARIDA
PESERTA
27/12/1975
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,315 0001604269899 1901014302690006
13
NATALIA
ANAK
03/02/1989
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,316 0001604269901 1901015811030008
13
NOVITA
ANAK
18/11/2003
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,317 0001604269912 1901010310120002
13
FAIZ MUHAMMAD FADLAN
ANAK
03/10/2012
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,318 0001604269923 1901016506880003
13
PUTRI SAFIRA
TAMBAHAN
25/06/1988
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,319 0001604269934 1901012403020003
13
ABDUL RACHMAN FIRDAUS
TAMBAHAN
24/03/2002
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,320 0001604269945 1901011808800006
19
YUDI SISWANTO
PESERTA
18/08/1980
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 275 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,321 0001604269956 1901014205930002
19
SHANTY INDRIYANI
ISTRI
02/05/1993
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,322 0001604269967 1901012807110003
19
ASYQAR YUSA
ANAK
28/07/2011
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,323 0001604269978 1901014903730002
26
SYAM SURYANA
PESERTA
09/03/1973
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,324 0001604269989 1901010101950007
26
M.AWANG ARMANSYAH
ANAK
01/01/1995
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,325 0001604269991 1901011712980004
26
DIMAS KRISNA
ANAK
17/12/1998
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,326 0001604270002 1901014310040001
26
DINDA AISYAH
ANAK
03/10/2004
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,327 0001604270013 1901014510800007
31
SUKMA
PESERTA
05/10/1980
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,328 0001604270024 1901010505980007
31
ALDI
ANAK
05/05/1998
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,329 0001604270035 1901015304070002
31
INTAN
ANAK
13/04/2007
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,330 0001604270046 1901010406600002
34
BADRUN
PESERTA
04/06/1960
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,331 0001604270057 1901012008900007
34
REZA BADRIL
ANAK
20/08/1992
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,332 0001604270068 1901015112050003
34
HIDAYAH
ANAK
11/12/2005
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,333 0001604270079 1901015905670002
39
YENDRAWATI
PESERTA
29/05/1967
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,334 0001604270081 1901016311740001
39
MEGAWATYCHENDRAWAN
TJHIN
ANAK
23/11/1974
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,335 0001604270092 1901017007760003
39
HEURIANA CHENDRAWAN
TJHIN
ANAK
30/07/1976
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,336 0001604270103 1901011611640003
42
MUNANDAR
PESERTA
16/11/1964
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,337 0001604270114 1901014207730004
42
KAMSINA
ISTRI
02/07/1973
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,338 0001604270125 1901012303800007
44
MARZUAN
PESERTA
23/03/1980
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,339 0001604270136 1901017005780005
44
MELIYANTI
ISTRI
30/05/1978
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,340 0001604270147 1901016205030004
44
MEYSI PRASISKA
ANAK
22/05/2003
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,341 0001604270158 1901015305070001
44
MEIRISKA
ANAK
13/05/2007
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,342 0001604270169 1901015305130002
44
MEYRIANTI
ANAK
13/05/2013
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 276 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,343 0001604270171 1901012001660001
49
SYAHRUDIN
PESERTA
20/01/1966
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,344 0001604270182 1901016007700007
49
SULASTRI
ISTRI
20/07/1970
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,345 0001604270193 1901016907890004
49
JULIA PUTRI
ANAK
29/07/1989
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,346 0001604270204 1901012711960004
49
REZI SAPUTRA
ANAK
27/11/1996
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,347 0001604270215 1901011001000004
49
RIZAL RAHMANA PUTRA
ANAK
10/01/2000
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,348 0001604270226 1901011205080002
49
MUHAMMAD FAYRUZ
ANAK
12/05/2008
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,349 0001604270237 1901012208050005
57
CARLOS NOVIYANTO
PESERTA
22/08/2005
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,350 0001604270248 1901012206970001
58
SANDI SAFREDO
PESERTA
27/06/1997
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,351 0001604270259 1901011111020002
58
RIZKI SAFREDO
ANAK
11/11/2002
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,352 0001604270261 1901012311880002
60
ANDIANSYAH
PESERTA
23/11/1988
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,353 0001604270272 1901015408990001
60
AMERIA OKTAVIANI
ANAK
14/08/1999
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,354 0001604270283 1901015510030001
60
SELLA
ANAK
15/10/2003
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,355 0001604270294 1901012403080001
60
SHONIEL SANDRA
ANAK
24/03/2008
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,356 0001604270305 1901012012760001
60
ALEK
TAMBAHAN
20/12/1976
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,357 0001604270316 1901012004890003
67
AFRIZAL
PESERTA
10/04/1989
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,358 0001604270327 1901011112720002
68
JUMANI ARDIANTO
PESERTA
11/12/1972
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,359 0001604270338 1901015209760008
68
SAROPAH
ISTRI
12/09/1976
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,360 0001604270349 1901012512990005
68
YOHANES AFRIANTO
ANAK
25/12/1999
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,361 0001604270351 1901016908070008
68
EGI PUTRI ADELIA
ANAK
29/08/2007
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,362 0001604270362 1901010810950001
75
ARGA WIRANDA
PESERTA
08/10/1995
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,363 0001604270373 1901012002700002
76
AMRI
PESERTA
20/02/1970
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,364 0001604270384 1901016709790002
76
SAFITRI
ISTRI
27/09/1979
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,365 0001604270395 1901010804010002
76
WAHYU AL AFGAN
ANAK
08/04/2001
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 277 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,366 0001604270406 1901015102060001
76
WIDYA ASPIRANDA
ANAK
11/02/2006
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,367 0001604270417 1901010811730001
81
EDI BAMBANG GUSTIAWAN
PESERTA
08/11/1973
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,368 0001604270428 1901014208770001
81
ZAKIYAH
ISTRI
02/08/1977
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,369 0001604270439 1901013011980003
81
MUHAMMAD ZAKKY
ANAK
30/11/1998
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,370 0001604270441 1901016003040003
81
IFRA AULIA
ANAK
20/03/2004
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,371 0001604270452 1901012209880001
87
ANDRE KRISTIAN
PESERTA
22/09/1988
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,372 0001604270463 1901010404720009
91
HERI BAMBANG KURNIAWAN
PESERTA
04/04/1972
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,373 0001604270474 1901016712720001
91
ROSYDA
ISTRI
27/12/1972
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,374 0001604270485 1901012111970006
91
MUHAMMAD HERY SAPUTRA
ANAK
21/11/1997
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,375 0001604270496 1901016010010009
91
VIRJINIA PUTRY UTAMI
ANAK
20/10/2001
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,376 0001604270507 1901013112870001
99
RUSDI PUTRA
PESERTA
31/12/1987
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,377 0001604270518 1901015112920002
99
KARTINI
ANAK
11/12/1992
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,378 0001604270529 1901012507950001
99
ADE PUTRA YONO
ANAK
25/07/1995
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,379 0001604270531 1901012203870005
99
FAISAL MUSTIKA
ANAK
22/03/1997
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,380 0001604270542 1901012504000002
99
BUSTOMI
ANAK
25/04/2000
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,381 0001604270553 1901010506050001
99
INDRA BARROKAH
ANAK
05/06/2005
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,382 0001604270564 1901016612040001
105
YESSY NATALIANA
PESERTA
26/12/2004
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,383 0001604270575 1901010305110002
105
M.AKBAROKAH ZUHIR YASIR
ANAK
03/05/2011
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,384 0001604270586 3526100107581121
111
SUBEIRI
PESERTA
01/07/1968
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,385 0001604270597 3526164107720431
111
SARI'A
ISTRI
01/07/1972
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,386 0001604270608 3526100107911209
111
SAMSUL
ANAK
01/07/1991
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,387 0001604270619 1901010805820003
114
RIZKI PRATAMA
PESERTA
08/08/1982
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,388 0001604270621 3528904167940625
114
SUMAMI
ISTRI
01/07/1984
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 278 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,389 0001604270632 1901012406890001
116
HENDRA
PESERTA
24/06/1989
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,390 0001604270643 1901015706980001
116
ELA SARI
ANAK
17/06/1998
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,391 0001604270654 1901016008090001
116
A.ADILLA
ANAK
20/08/2009
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,392 0001604270665 1901012305960008
119
MUHAMMAD KRESNA
PESERTA
23/05/1996
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,393 0001604270676 1901011507000008
119
MUHAMMAD AMRULLAH
ANAK
15/07/2000
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,394 0001604270687 1901015803950002
121
SRI NENGSIH
PESERTA
18/03/1995
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,395 0001604270698 3320070311990003
121
MUHAMMAD REDHO
ANAK
21/11/1999
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,396 0001604270709 3320076811060002
121
ALYA NUR SYAFA'AH
ANAK
28/11/2008
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,397 0001604270711 1901013008620004
124
N.HARIYANTO
PESERTA
30/08/1962
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,398 0001604270722 1901016707670007
124
RATIYAH
ISTRI
27/07/1967
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,399 0001604270733 1901016309000004
124
SEPTI NADIA
ANAK
23/09/2000
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,400 0001604270744 1901015811030007
124
AULIA AISYAH
ANAK
18/11/2003
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,401 0001604270755 1901010508900001
129
RAMASTI TRISASWITA
PESERTA
05/08/1990
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,402 0001604270766 1901014501780003
131
VIEN EKASARI
PESERTA
05/01/1978
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,403 0001604270777 1901017103090001
131
SAFA NAYLA
ANAK
31/03/2009
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,404 0001604270788 1901014804680003
134
HASNAINI
PESERTA
08/04/1968
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,405 0001604270799 1901015103740002
134
HENDRYANTI
ANAK
11/03/1974
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,406 0001604270801 1901012805590001
136
ZUL JALAL AHAD
PESERTA
28/05/1959
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,407 0001604270812 1901016709590001
136
JAINATI
ISTRI
27/09/1959
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,408 0001604270823 1901012411870001
136
ADYTYA
ANAK
24/11/1987
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,409 0001604270834 1901012206600002
141
MUSTADI
PESERTA
22/06/1960
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,410 0001604270845 1901014107520003
141
TIJAH
ISTRI
01/07/1952
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,411 0001604270856 1901014208900003
141
JURAIDA
ANAK
02/08/1990
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 279 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,412 0001604270867 1901013108810005
144
ASTYANDI FIRDAUS
PESERTA
31/08/1981
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,413 0001604270878 1901011501780005
145
YUYUN GUANTORO
PESERTA
15/01/1978
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,414 0001604270889 1901012605580001
146
SYAMSUDIN
PESERTA
26/05/1958
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,415 0001604270891 1901016004610001
146
HALIPAH
ISTRI
20/04/1961
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,416 0001604270902 1901012803810001
146
SYAFRI
ANAK
28/03/1981
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,417 0001604270913 1901010509890001
146
SYAHRIAL
ANAK
05/09/1989
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,418 0001604270924 1901010306900001
146
SYAHRIL
ANAK
03/06/1990
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,419 0001604270935 1901012812680001
151
DJUNAIDI
PESERTA
28/12/1968
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,420 0001604270946 1901015010740001
151
ERNA WATI
ISTRI
10/10/1974
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,421 0001604270957 1901012607940001
151
ERWINSYAH
ANAK
26/07/1994
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,422 0001604270968 1901015207990001
151
ERVINA YULIANIKA
ANAK
12/07/1999
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,423 0001604270979 1901011400716062
155
MUHAMMAD FIORI
PESERTA
14/04/1971
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,424 0001604270981 1901018606700007
155
MURNI
ISTRI
26/06/1979
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,425 0001604270992 1901018010010001
155
ZIYARA OKTAVIANI
ANAK
10/10/2001
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,426 0001604271003 1901011004100003
155
ROBY ALFREDO
ANAK
10/04/2010
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,427 0001604271014 1901011202810004
159
PEBY MARYONO
PESERTA
12/02/1981
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,428 0001604271025 1901016407840001
159
ELIKA SUSANTI
ISTRI
24/07/1984
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,429 0001604271036 1901016708140001
159
JIHAN VELYKA AUGUSTIA
ANAK
27/08/2014
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,430 0001604271047 1901015205520004
163
SRI BANIAH
PESERTA
12/05/1952
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,431 0001604271058 1901012502840003
166
ARIANTO
PESERTA
25/02/1984
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,432 0001604271069 1901016107860004
166
LIS YULIANTI
ISTRI
21/07/1988
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,433 0001604271071 1901011910090001
166
RIZKY YULIANTO
ANAK
19/10/2009
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,434 0001604271082 1901013011130003
166
DWI YULIANTO
ANAK
30/11/2013
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 280 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,435 0001604271093 1901010401420001
170
ASARI THALIB
PESERTA
04/01/1942
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,436 0001604271104 1901015507320001
170
ROTENI DJAMIN
ISTRI
15/07/1932
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,437 0001604271115 1901015012530003
170
HAYUTI
ANAK
10/12/1953
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,438 0001604271126 1901016302960001
170
LINTANG DWI PRATIWI
TAMBAHAN
23/02/1998
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,439 0001604271137 1901012106880003
174
DZULQORNAIN
PESERTA
21/06/1988
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,440 0001604271148 1901016004900004
174
UTA LESTARI
ISTRI
20/04/1990
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,441 0001604271159 1901012411700001
178
SUHARLI
PESERTA
24/11/1970
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,442 0001604271161 1901015005790007
178
SITI JURAINI
ISTRI
10/05/1979
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,443 0001604271172 1901015210980006
178
DEA AYU LESTARI
ANAK
12/10/1999
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,444 0001604271183 1901017012030003
178
ANJUA
ANAK
30/12/2003
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,445 0001604271194 1901010602100007
178
ZAIZ JUBER
ANAK
08/02/2010
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,446 0001604271205 1901014712830003
184
ZURNIATI
PESERTA
07/12/1983
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,447 0001604271216 1901010903690001
186
MOHAMAD
PESERTA
09/03/1989
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,448 0001604271227 1901011011700006
186
RUSIH
ANAK
10/11/1970
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,449 0001604271238 1901016312880002
192
RISSA NATASHA
PESERTA
23/12/1988
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,450 0001604271249 1901012209690001
197
RAMZUL
PESERTA
22/09/1969
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,451 0001604271295 1901012806880004
204
ADE SURYONO
PESERTA
26/09/1988
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,452 0001604271306 1901016901880002
204
FORWITA
ISTRI
29/09/1988
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,453 0001604271317 1901012501140003
204
ZALFIN NUGRAHA
ANAK
25/01/2014
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,454 0001604271328 1901012501140002
204
ZALFAN SUGIARTA
ANAK
25/01/2014
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,455 0001604271339 1901011909610002
223
YANTO
PESERTA
19/09/1961
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,456 0001604271341 1901016304640003
227
TINA
PESERTA
23/04/1964
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,457 0001604271352 1901016701900007
227
ELLISSA
ANAK
27/01/1990
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 281 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,458 0001604271363 1901011708760006
231
AGUS SUTOYO
PESERTA
17/08/1976
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,459 0001604271374 1901016803800001
231
MARWATI
ISTRI
28/03/1980
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,460 0001604271385 1901014703120002
231
MARITA
ANAK
07/03/2012
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,461 0001604271396 1901011809660001
234
SYAHRUL
PESERTA
18/09/1966
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,462 0001604271407 1901015911650001
234
ARYANI
ISTRI
19/11/1965
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,463 0001604271418 1901015706930001
234
ANNANDHA RUNNY LESTARY
ANAK
17/06/1993
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,464 0001604271429 1901011004480001
237
DAINO B BAJJURI
PESERTA
10/04/1948
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,465 0001604271431 1901015305490001
237
SRI ROHATI
ISTRI
13/05/1949
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,466 0001604271442 1901013009740001
237
SUBRATA
ANAK
30/09/1974
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,467 0001604271453 1901011107770003
240
SUHERMAN
PESERTA
11/07/1977
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,468 0001604271464 1901014111840002
240
SAMSERAH
ISTRI
01/11/1984
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,469 0001604271475 1901015612040004
240
SURTINI
ANAK
16/12/2004
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,470 0001604271486 1901012108540002
243
SUWARDI
PESERTA
21/08/1954
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,471 0001604271497 1901014112550002
243
KASMI
ISTRI
01/12/1955
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,472 0001604271508 1901011103790001
243
DONI WAHYUDI
ANAK
11/03/1979
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,473 0001604271519 1901014907630001
255
SUMIRAH
PESERTA
09/07/1963
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,474 0001604271521 1901010606870006
256
REDI SAPUTRA
PESERTA
06/06/1987
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,475 0001604271532 1901011603620005
259
MUHAMMAD RASYID
PESERTA
16/03/1962
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,476 0001604271543 1901016709670002
259
RUSTINA
ISTRI
27/09/1967
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,477 0001604271554 1901012502970005
265
NOVA FEBRIAN
PESERTA
25/02/1997
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,478 0001604271565 1901011410610001
266
MARSONGKO
PESERTA
14/10/1961
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,479 0001604271576 1901017005620001
266
JAKAWATI
ISTRI
30/05/1962
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,480 0001604271587 1901011411960003
266
ARYA PUTRA
ANAK
14/11/1996
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 282 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,481 0001604271598 1901011404830008
271
ASIM
PESERTA
14/04/1983
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,482 0001604271609 1901014112910003
271
DERI KARYATI
ISTRI
01/12/1991
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,483 0001604271611 1901013008090002
271
SETEVEN DARMA PUTRA
ANAK
30/08/2009
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,484 0001604271622 1901010910790006
282
SUMARNO
PESERTA
09/10/1979
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,485 0001604271633 1901016004870005
282
FITRIYANTI
ISTRI
20/04/1987
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,486 0001604271644 1901010306070002
282
ANDREAN AKBAR PRATAMA
ANAK
03/06/2007
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,487 0001604271655 1901016008450001
287
ROSANIK
PESERTA
20/08/1948
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,488 0001604271666 1901011305660001
291
JUMADI
PESERTA
13/05/1966
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,489 0001604271677 1901016303640002
291
NANI SUSILAWATI
ISTRI
23/03/1964
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,490 0001604271688 1901012607000004
291
ANANDA PUJO GUSTI LANANG ANAK
26/07/2000
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,491 0001604271699 1901012508870002
291
RONALDO
TAMBAHAN
25/08/1987
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,492 0001604271701 1901015309930003
291
POPPY EVALIANI
TAMBAHAN
13/09/1993
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,493 0001604271712 1901010805800002
296
HENDI DINARTA
PESERTA
08/05/1980
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,494 0001604271723 1901014702790007
296
SURYATI
ISTRI
07/02/1979
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,495 0001604271734 1901011402090001
296
YUDI VALINTINO
ANAK
14/02/2009
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,496 0001604271745 1901012608110004
296
IRWAN AGUSTIAN
ANAK
26/08/2011
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,497 0001604271756 1901010412590004
304
SUMADI
PESERTA
04/12/1959
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,498 0001604271767 1901017112630004
304
ROSIDAH
ISTRI
31/12/1963
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,499 0001604271778 1901012007970005
304
ZULKIFLI
ANAK
20/07/1997
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,500 0001604271789 1901015506580005
307
KARTINI
PESERTA
15/06/1958
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,501 0001604271791 1901012408320001
308
YUSUF HARUN
PESERTA
24/08/1932
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,502 0001604271802 1901014102390002
308
MUSLIMAH
ISTRI
01/02/1939
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,503 0001604271813 1901010211500001
308
YUSLIDAR
ANAK
02/11/1960
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 283 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,504 0001604271824 1901011606700002
311
SUPRATMAN
PESERTA
16/06/1970
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,505 0001604271835 1901010502340001
312
SUDARNO
PESERTA
05/02/1934
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,506 0001604271846 1901014410470003
312
SITI
ISTRI
04/10/1947
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,507 0001604271857 1901010506620003
315
HUSDANI
PESERTA
05/06/1962
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,508 0001604271868 1901014507650004
315
ZUNIATI
ISTRI
05/07/1965
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,509 0001604271879 1901011804660007
315
MARIYO
ANAK
18/04/1985
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,510 0001604271881 1901012111640002
320
MARIONO
PESERTA
21/11/1964
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,511 0001604271892 1901014707650005
320
JUMAINAH
ISTRI
07/07/1965
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,512 0001604271903 1901010904890006
320
MARSIH
ANAK
09/04/1989
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,513 0001604271914 1901010707000003
320
RIAN
ANAK
07/07/2000
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,514 0001604271925 1901011900060003
320
MEDIKA
ANAK
19/06/2006
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,515 0001604271936 1901012702690002
326
ASAHI AR
PESERTA
27/02/1969
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,516 0001604271947 1901016203730004
326
UMI SUGIARTI
ISTRI
22/03/1973
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,517 0001604271958 1901010605030003
332
RENDY PRAYOGA
PESERTA
06/05/2003
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,518 0001604271969 1901015002470001
335
MUHERI
PESERTA
10/02/1947
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,519 0001604271971 1901011010780007
335
RUSMALI
ANAK
10/10/1978
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,520 0001604271982 1901015708620008
342
RITA GUFRINI
PESERTA
17/08/1962
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,521 0001604271993 1901015211940001
342
EKA NOVIANTI
ANAK
12/11/1994
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,522 0001604272004 1901016802010005
342
PUTRI ANDREANI
ANAK
28/02/2001
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,523 0001604272015 1901013107710002
345
PURWANTO
PESERTA
31/07/1971
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,524 0001604272026 1901015210760002
345
MURNIATI
ISTRI
12/10/1976
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,525 0001604272037 1901011709990001
345
RYAN
ANAK
17/09/1999
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,526 0001604272048 1901011102440001
349
TURUT RIADI
PESERTA
11/02/1944
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 284 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,527 0001604272059 1901014403530001
349
SUNARTI
ISTRI
04/03/1953
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,528 0001604272061 1901011212810002
349
DIDI HARYADI
ANAK
12/12/1981
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,529 0001604272072 1901014402890003
349
SRI UTARI
ANAK
04/02/1989
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,530 0001604272083 1901012210220001
353
KIBUN KARSO PRAWIRO
PESERTA
22/10/1922
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,531 0001604272094 1901015805360001
353
PASINAH
ISTRI
18/05/1936
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,532 0001604272105 1901010111720001
353
PANTORO
ANAK
01/11/1972
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,533 0001604272116 1901011207590001
358
KARMIN
PESERTA
12/07/1959
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,534 0001604272127 1901015505620002
358
TARUPI
ISTRI
15/05/1962
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,535 0001604272138 1901010607880001
358
SUTARDI
ANAK
06/07/1988
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,536 0001604272149 1901015405940004
358
SRI SULASTRI
ANAK
14/05/1994
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,537 0001604272151 1901014312690002
362
RUSMINI
PESERTA
03/12/1969
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,538 0001604272162 1901010902570002
370
RIDUAN
PESERTA
09/02/1957
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,539 0001604272173 1901015009620001
370
MARIANA
ISTRI
10/09/1962
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,540 0001604272184 1901013001870001
370
RIDHOMA
ANAK
30/01/1987
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,541 0001604272195 1901012212980001
370
AL AKHBAR
ANAK
22/12/1998
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,542 0001604272206 1901011412740005
375
BUDI DARWIN
PESERTA
14/12/1974
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,543 0001604272217 1901010802820001
382
MUGIONO
PESERTA
08/02/1982
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,544 0001604272228 1901011303070005
382
AHMAD IDRIS PRATAMA
ANAK
13/03/2007
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,545 0001604272239 1901015011600004
390
SUMARNI
PESERTA
20/11/1960
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,546 0001604272241 1901012605870001
390
SLAMET SETIAWAN
ANAK
25/05/1987
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,547 0001604272252 1901012007720001
394
WARYANTO
PESERTA
20/07/1972
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,548 0001604272263 1901016410730001
394
M.A.PURNAMASARI DEVI
ISTRI
24/10/1973
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,549 0001604272274 1901012703990004
394
FADHIL IZDIHAR
ANAK
27/03/1999
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 285 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,550 0001604272285 1901014803020001
394
AZZAH RIMA FIRASTI
ANAK
08/03/2002
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,551 0001604272296 1901011105080002
394
FIRYAL SYAFIQ
ANAK
11/05/2008
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,552 0001604272307 1901012911770001
399
SUYANTO
PESERTA
29/11/1977
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,553 0001604272318 1901015010770001
399
KUSUMAWATI
ISTRI
10/10/1977
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,554 0001604272329 1901016603990001
399
KUSUMASARI
ANAK
26/03/1999
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,555 0001604272331 1901016008020001
399
ANGGI NAVIATUL NURUL

AVIVA
ANAK
20/08/2002
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,556 0001604272342 1901015208080001
399
ALMAHERA AZZAHRA
ANAK
12/08/2008
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,557 0001604272353 1901011010820011
404
EDI ZUSMANTO
PESERTA
10/10/1962
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,558 0001604272364 1901016011780010
404
MARIYANI
ISTRI
20/11/1978
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,559 0001604272375 1901014812010002
404
DESTI RAHMAYANTI
ANAK
08/12/2001
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,560 0001604272386 1901014801040001
404
DELVI REDIYANI
ANAK
08/01/2004
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,561 0001604272397 1901014308060001
404
AUDIAH AGRA CELITA
ANAK
03/08/2005
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,562 0001604272408 1901011802130003
404
GENTA FEBRIANSYAH
ANAK
18/02/2013
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,563 0001604272419 1901010909680009
416
SUDARWIN
PESERTA
09/09/1968
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,564 0001604272421 1901012303760004
419
YANTO
PESERTA
23/02/1976
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,565 0001604272432 1901014809790001
419
SULISDA
ISTRI
08/09/1979
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,566 0001604272443 1901016508990002
419
RIRIN APRISKA
ANAK
25/08/1999
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,567 0001604272454 1901016911070001
419
NOVA ANGELA
ANAK
29/11/2007
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,568 0001604272465 1901010811490001
423
KUSIRAN BIN BAHARUS
PESERTA
08/11/1949
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,569 0001604272476 1901016312520001
423
DALMINA ADENAN
ISTRI
23/12/1952
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,570 0001604272487 1901015411750005
423
ANISA
ANAK
14/11/1975
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,571 0001604272498 1901012110670002
431
SUNYOTO
PESERTA
21/10/1967
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,572 0001604272509 1901016611700004
431
ROHMAH
ISTRI
26/11/1970
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 286 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,573 0001604272511 1901015102960002
431
WIWI MUNJAYANAH
ANAK
11/02/1996
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,574 0001604272522 1901011812810005
436
DEDI SUSANTO
PESERTA
18/12/1981
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,575 0001604272533 1901014412500001
439
MURNI
PESERTA
04/12/1960
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,576 0001604272544 1901014707820001
439
WINDI
ANAK
07/07/1982
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,577 0001604272555 1901015508860001
439
YULIANA
ANAK
15/08/1986
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,578 0001604272566 1901015707980000
449
ENI SINTIA
PESERTA
17/07/1998
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,579 0001604272577 1901010405540002
454
WARDJAN
PESERTA
04/05/1954
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,580 0001604272588 1901016212540006
454
GARNASIH
ISTRI
22/12/1964
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,581 0001604272599 1901012804790002
460
ZAINAL ABIDIN
PESERTA
28/04/1979
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,582 0001604272601 1901015611800009
460
WISTRIA NOVIKUSIANTI
ISTRI
16/11/1980
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,583 0001604272612 1901015003080001
460
ZALYA AZZAHRA
ANAK
10/03/2008
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,584 0001604272623 1901012809110001
460
HUSEN ALI
ANAK
28/09/2011
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,585 0001604272634 1901012910700001
464
ENGGI HERMAN
PESERTA
29/10/1970
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,586 0001604272645 1901015203730012
464
ASUNA
ISTRI
12/03/1973
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,587 0001604272656 1901012807970001
464
ERSAN
ANAK
23/07/1997
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,588 0001604272667 1901014404070001
464
ELSA ANGGORIANI
ANAK
04/04/2007
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,589 0001604272678 1901012404730001
468
APRI GUNARTO
PESERTA
24/04/1973
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,590 0001604272689 1901014706730003
468
STIORINI
ISTRI
07/06/1973
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,591 0001604272691 1901010110300002
468
SARDJONO
TAMBAHAN
01/10/1930
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,592 0001604272702 1901016604100003
477
AYU APRILIA
PESERTA
26/04/2010
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,593 0001604272713 1901011509910001
478
ARIPIN
PESERTA
15/09/1991
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,594 0001604272724 1901074607930003
478
MENTARI
ISTRI
06/07/1993
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,595 0001604272735 1901012107810001
491
ROMLI
PESERTA
21/07/1981
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 287 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,596 0001604272746 1901016405880003
491
MINA
ISTRI
24/05/1988
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,597 0001604272757 1901015411060004
491
FAIZA TUN NUFUS
ANAK
14/11/2006
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,598 0001604272768 1901014197999923
506
SRI JULIANTI
PESERTA
01/07/2010
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,599 0001604272779 1901012411580002
507
HIU MUK ON
PESERTA
24/11/1958
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,600 0001604272781 1901015410940004
507
DEVI YULIANTI
ANAK
14/10/1994
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,601 0001604272792 1901012811960005
507
HENDRIANTO
ANAK
28/11/1996
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,602 0001604272803 1901011208680003
511
IDRUS
PESERTA
12/08/1968
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,603 0001604272814 3213145507720000
511
IMAS YULIANTI
ISTRI
15/07/1972
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,604 0001604272825 1901015401030002
511
VERAWATI
ANAK
14/01/2003
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,605 0001604272836 1901012008040002
511
ROBI KURNIAWA
ANAK
20/08/2000
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,606 0001604272847 3213146706000007
511
GINA MAULIDA
TAMBAHAN
17/08/2000
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,607 0001604272858 3213144102030014
511
SUCI RAHMAWATI
TAMBAHAN
01/02/2003
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,608 0001604272869 1901010101480008
517
ACHMAD MIRZA
PESERTA
01/01/1948
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,609 0001604272871 1901010707400001
518
ACHMAD BIN JAIMIN
PESERTA
07/07/1940
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,610 0001604272882 1901014710480003
518
ROMIMAH
ISTRI
07/10/1948
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,611 0001604272893 1901015104770002
518
KUSNAWATI
ANAK
11/04/1977
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,612 0001604272904 1901015804800008
518
DEWI YANTI
ANAK
16/04/1980
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,613 0001604272915 1901012909720005
522
RUSMIADI
PESERTA
29/09/1972
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,614 0001604272926 1901014103720003
522
RAHMAWATI
ISTRI
01/03/1972
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,615 0001604272937 1901010404010008
522
HENDRO
ANAK
04/04/2001
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,616 0001604272948 1901016503050009
522
ANANDA SALASABILA
ANAK
25/03/2005
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,617 0001604272959 1901015404110001
522
ANISA AFRILIA
ANAK
14/04/2011
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,618 0001604272961 1901012905830005
527
HASAN BASRI
PESERTA
29/05/1983
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 288 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,619 0001604272972 1901016805780005
527
SULENA
ISTRI
28/05/1988
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,620 0001604272983 1901014602090001
527
FEIDINA MEZANI
ANAK
26/02/2009
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,621 0001604272994 1901015912820001
531
SRI WIDARI
PESERTA
19/12/1982
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,622 0001604273005 1901011211020002
531
FARANDIKA KUSUARA CIPTA
ANAK
12/11/2002
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,623 0001604273016 1901014602080001
531
SHERIN NIADILLAH ILMI
ANAK
06/02/2008
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,624 0001604273027 1901010308670001
542
SAMIDI
PESERTA
03/08/1967
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,625 0001604273038 1901011605950001
542
SUFENDRA
ANAK
16/05/1995
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,626 0001604273049 1901015404750000
548
HAINI
PESERTA
14/04/1975
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,627 0001604273051 1901012703990005
548
CHANDRA WIJAYA
ANAK
27/03/1975
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,628 0001604273062 1901011202070003
548
RANGGA FEBRIANSYAH
ANAK
12/02/2007
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,629 0001604273073 1901011006730003
574
JUNIZAR ABDULLAH
PESERTA
10/06/1973
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,630 0001604273084 1901015405020006
574
ANINAH
ISTRI
14/05/1982
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,631 0001604273095 1901015609020001
574
SEPTI RAVHMAWATI
ANAK
16/09/2002
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,632 0001604273106 1901010502400004
577
ABDULLAH ADIS
PESERTA
05/02/1940
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,633 0001604273117 1901014701390009
577
ASNAH
ISTRI
07/01/1939
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,634 0001604273128 1901010210720001
579
ASBULLAH
PESERTA
02/10/1972
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,635 0001604273139 1901015606770002
579
SURYA LIMIYATI
ISTRI
16/06/1977
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,636 0001604273141 1901012606010001
579
RIVALDO ASMETA
ANAK
26/08/2001
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,637 0001604273152 1901011201060001
579
GATHAN SASTRA WIJAYA
ANAK
12/01/2006
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,638 0001604273163 1901012305620001
583
RASIDI SANUSI
PESERTA
23/05/1952
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,639 0001604273174 1901015006540002
583
ZUNIAR
ISTRI
10/05/1954
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,640 0001604273185 1901010301790006
588
ABDUL MARLIA HAYCI AZWAR PESERTA
03/01/1979
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,641 0001604273196 1901016706860004
588
JUNIATI
27/06/1986
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
ISTRI
Page 289 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,642 0001604273207 1901012001110012
588
ABDUL MUHJIARWAN
ANAK
16/08/2004
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,643 0001604273218 1901015706860004
588
RAUUF NADHFA
ANAK
03/08/2008
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,644 0001604273229 1901011608040005
588
MUKHLISH JAAD
ANAK
10/01/2011
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,645 0001604273231 1901010711580001
594
BUSRONI
PESERTA
07/11/1958
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,646 0001604273242 1901014508670005
594
GUSTI
ISTRI
05/08/1967
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,647 0001604273253 1901013001550001
605
ABU ASRI
PESERTA
30/01/1955
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,648 0001604273264 1901014208520004
605
HATUTI
ISTRI
02/08/1952
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,649 0001604273275 1901011910790003
605
AGUSTIANSYAH
ANAK
19/10/1979
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,650 0001604273286 1901013012840005
605
KHAIRUL ANWAR
ANAK
30/12/1984
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,651 0001604273297 1901016107680004
605
ERNI HERAWATI
ANAK
21/07/1988
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,652 0001604273308 1901010606370002
610
SYAMSUDIN TAMAN
PESERTA
06/06/1937
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,653 0001604273319 1901014507340001
610
MARIANA
ISTRI
05/07/1934
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,654 0001604273321 1901010706830003
610
EFENDI
ANAK
07/05/1983
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,655 0001604273332 1901011705790004
610
EDDY
ANAK
17/05/1983
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,656 0001604273343 1901012305810005
614
WENDI KUSWENDI
PESERTA
23/05/1981
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,657 0001604273354 1901016410780005
614
OCTAVIANI
ISTRI
24/10/1978
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,658 0001604273365 1901015207050003
614
GELIA CERITA KUSUMA
ANAK
12/07/2005
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,659 0001604273376 1901016707060008
614
NATASYAH ALFINIA KUSUMA
ANAK
27/07/2006
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,660 0001604273387 1901011808810002
618
AUGUSTIAN BINTARA
PESERTA
18/08/1981
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,661 0001604273398 1901015508750008
618
EFI AGUSTIANI
ISTRI
15/08/1975
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,662 0001604273409 1901014312040003
618
INDAH PUTRI
ANAK
03/12/2004
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,663 0001604273411 1901016302080001
618
MONICA PUTRI MAHARANI
ANAK
23/02/2008
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,664 0001604273422 1901014405100002
618
SYAKHILLA PUTRI MAHARANI
ANAK
04/05/2010
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 290 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,665 0001604273433 1901010312630003
624
SUPRIYATNO
PESERTA
03/12/1983
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,666 0001604273444 1901015808720004
624
ELVANI BRIGIDA
ISTRI
18/08/1972
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,667 0001604273455 1901011907960001
624
SHINDU ABDINATA
ANAK
19/07/1996
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,668 0001604273466 1901014112020007
624
DWI SANTI SAFITRI
ANAK
01/12/2002
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,669 0001604273477 1901010206540003
628
SURYA KUSUMA
PESERTA
10/06/1973
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,670 0001604273488 1901014710540001
628
HAZIZAH
ISTRI
07/10/1954
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,671 0001604273499 1901010309860005
628
EDI FITRA
ANAK
03/09/1986
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,672 0001604273501 1901011512880001
628
NURUL IMAM RIANDI
ANAK
15/12/1988
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,673 0001604273512 1901016907910001
628
NORA NANDAULAN SARI
ANAK
20/07/1991
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,674 0001604273523 1901010507820010
639
SUPRIYANDI
PESERTA
05/07/1982
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,675 0001604273534 1901015804840004
639
ELFA SUPATMAWATI
ISTRI
18/04/1984
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,676 0001604273545 1901012606050004
639
RANDIKA ZAKI PRATAMA
ANAK
20/08/2005
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,677 0001604273556 1901015706100001
639
KARISMA DWI CINTA
ANAK
17/06/2010
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,678 0001604273567 1901010108740001
646
AGUS SUPRIYANTO
PESERTA
01/08/1974
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,679 0001604273578 1901015907980001
646
MYSI APRILLIA
ANAK
19/07/1998
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,680 0001604273589 1901017105050002
646
MARSELLA AGUSTINA
ANAK
31/05/2005
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,681 0001604273591 1901011103660006
654
HENDRA
PESERTA
11/03/1966
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,682 0001604273602 1901017003710004
654
HENNY
ISTRI
30/03/1971
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,683 0001604273613 1901012209950002
654
HERDIAN WIJAYA
ANAK
22/09/1995
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,684 0001604273624 1901016708000003
654
INDAH INDRIYANI
ANAK
27/08/2000
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,685 0001604273635 1901013108580004
658
JOHAN GRIP
PESERTA
31/08/1956
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,686 0001604273646 1901017112630008
658
MARYATI
ISTRI
31/12/1963
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,687 0001604273657 1901015212940012
658
JOSSI ARISTI
ANAK
12/12/1994
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 291 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,688 0001604273668 1901010404540003
663
SURYADI
PESERTA
04/04/1954
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,689 0001604273679 1901010403870003
664
EVAN SUHARJONO
PESERTA
04/08/1987
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,690 0001604273681 1901016608890002
664
LISNA SARI
ISTRI
26/08/1989
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,691 0001604273692 1901016410060002
664
SITI AULIA PUTRI
ANAK
24/10/2005
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,692 0001604273703 1901016708120000
664
SIFA ADINDA PUTRI
ANAK
27/08/2012
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,693 0001604273714 1901011603660008
668
MANGKA
PESERTA
16/03/1965
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,694 0001604273725 1901011003940003
668
GUSTANG
ANAK
10/03/1994
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,695 0001604273736 1901017107000001
668
SONIA
ANAK
31/07/2000
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,696 0001604273747 1901010205950001
674
ZULMI PUMAM JAYA
PESERTA
02/05/1995
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,697 0001604273758 1901015212950008
674
MAYA DESIANA
ISTRI
12/12/1995
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,698 0001604273769 1901015810120003
674
MIKHAYLA AHZAHRA PUTRI
ANAK
19/10/2012
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,699 0001604273771 1901010902800003
677
MARYADI
PESERTA
09/02/1980
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,700 0001604273782 1901016707830002
677
NUR ARYANTI
ISTRI
27/07/1983
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,701 0001604273793 1901011711030002
677
ABDILLAH PRATAMA
ANAK
17/11/2003
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,702 0001604273804 1901013107110003
677
IRWANSYAH PUTRA
ANAK
31/07/2011
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,703 0001604273815 1901012610720002
681
NURYAMIN
PESERTA
26/10/1972
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,704 0001604273826 1901016702760002
681
SULYATI
ISTRI
27/02/1976
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,705 0001604273837 1901011707960001
681
NUR PANDI
ANAK
17/07/1996
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,706 0001604273848 1901011211030005
681
FITRA RAMADHAN
ANAK
12/11/2003
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,707 0001604273859 1901011212720005
685
FAHMI
PESERTA
12/12/1972
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,708 0001604273861 1901016404740001
685
YULIANTI
ISTRI
24/04/1974
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,709 0001604273872 1901015610970002
685
OKTAVIANI
ANAK
16/10/1997
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,710 0001604273883 1901011703030001
685
MUHAMMAD IDHAM
ANAK
17/03/2003
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 292 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,711 0001604273894 1901012108830007
689
AGUS PRIYANTO
PESERTA
21/08/1983
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,712 0001604273905 1901017101810005
689
SUYA NIKSIH
ISTRI
31/01/1981
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,713 0001604273916 1901011503060003
689
M. HAFIIZH PRATAMA
ANAK
15/03/2006
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,714 0001604273927 1901010306620001
692
M. YUNUS
PESERTA
03/05/1982
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,715 0001604273938 1901011410668001
692
HERTININGSIH
ISTRI
01/06/1968
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,716 0001604273949 1901016808890001
692
RIKI HARTOYO
ANAK
24/09/1993
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,717 0001604273951 1901011907060001
692
ARIEL SAPUTRA
ANAK
19/07/2006
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,718 0001604273962 1901010808600010
697
PANDE LU
PESERTA
08/08/1960
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,719 0001604273973 1901014112620001
697
WASNAH
ISTRI
01/12/1962
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,720 0001604273984 1901011010870001
697
DEKA DIANA
ANAK
10/10/1987
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,721 0001604273995 1901011510900003
697
RIO ANATSARI
ANAK
15/09/1990
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,722 0001604274006 1901014504930004
697
RIA APRINA
ANAK
05/04/1993
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,723 0001604274017 1901013112580007
702
A. EDWAN EDI
PESERTA
31/12/1958
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,724 0001604274028 1901016001610036
702
MIKYALNI
ISTRI
20/01/1959
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,725 0001604274039 1901015004980004
702
EKA MAYANG SARI
ANAK
10/04/1996
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,726 0001604274041 1901010611700002
705
DIN DIN MUJAHIDIN
PESERTA
06/11/1970
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,727 0001604274052 1910101570780010
705
DJAN SE
ISTRI
17/07/1980
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,728 0001604274063 1901014401050004
705
FITRIANTI HERAWATI
ANAK
04/01/2005
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,729 0001604274074 1901010904410001
710
WIDADI ALBANI
PESERTA
09/04/1941
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,730 0001604274085 1901015707530001
710
SAINAH
ISTRI
17/07/1953
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,731 0001604274096 1901011119870001
710
WIDIANSYAH
ANAK
11/11/1987
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,732 0001604274142 1901010606370005
718
ALWI ARUP
PESERTA
06/07/1937
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,733 0001604274153 1901014604580008
718
ESI SUKESIH
ISTRI
06/04/1958
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 293 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,734 0001604274164 1901013112400003
721
LA SYAMSU
PESERTA
31/12/1940
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,735 0001604274175 1901010111880005
722
DWI NOVIANTO PRASETYO
PESERTA
01/11/1988
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,736 0001604274186 1901014308870002
722
CHITRA PUSPITA SARI
ISTRI
03/08/1987
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,737 0001604274197 1901011406100003
722
MUHAMMAD AL FARIZHI
ANAK
14/06/2010
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
6,738 0001604274208 1901084107580017
725
ANI
PESERTA
01/07/1958
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,739 0001604274219 1901081310850001
728
DARUL QUTENI
PESERTA
13/10/1985
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,740 0001604274221 1901086001860003
728
DEWI AYU SURYANI
ISTRI
20/01/1988
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,741 0001604274232 1901081605140001
728
GILMAN FAYYAD
ANAK
16/05/2014
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,742 0001604274243 1901080503450002
731
Sundjoko HS
PESERTA
05/03/1945
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,743 0001604274254 1901084406600001
731
Nurlela Atika
ISTRI
04/06/1960
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,744 0001604274265 1901080503830001
731
Anthony Jaka Dewa
ANAK
05/03/1983
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,745 0001604274276 1901081201940002
731
Dharmawan Agung Jaka Dewa
ANAK
12/01/1994
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,746 0001604274287 1901081108040001
731
Gloria Agustus Jaka Dewa
ANAK
11/08/2004
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,747 0001604274298 1901082409790002
736
Sahlil
PESERTA
24/09/1979
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,748 0001604274309 1901084709810001
736
Asnah
ISTRI
07/09/1981
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,749 0001604274311 1901086808070002
736
Siti Mega Aulia
ANAK
28/08/2007
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,750 0001604274322 1901081311130001
736
Barka Surotun
ANAK
13/11/2013
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,751 0001604274333 1901081709330004
740
Rakip
PESERTA
17/09/1933
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,752 0001604274344 1901084609410005
740
Jainah
ISTRI
06/09/1941
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,753 0001604274355 1901080501750006
740
Balen Rakip
ANAK
05/01/1975
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,754 0001604274366 1901082107860001
743
sugianto
PESERTA
27/08/1986
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,755 0001604274377 1901044108870002
743
hasmini
ISTRI
01/08/1987
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,756 0001604274388 1901082307120001
743
muhammad hilmi bignada
ANAK
23/07/2012
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 294 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,757 0001604274399 1901080508850002
746
riyan
PESERTA
05/08/1985
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,758 0001604274401 1901086507790001
746
yuliana
ISTRI
25/07/1979
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,759 0001604274412 1901086207040003
746
indri riyana
ANAK
22/07/2004
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,760 0001604274423 1901085406090001
746
revalina riyan saputri
ANAK
14/06/2009
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,761 0001604274434 1901030411680001
780
INDRA SAHLAN
PESERTA
11/04/1968
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,762 0001604274445 1901032105520001
790
IMRANUDIN BAKSIN
PESERTA
21/05/1952
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,763 0001604274456 1901034705610001
802
KARTINA
PESERTA
05/07/1961
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,764 0001604274467 1901034107540016
807
BUNIYAH
PESERTA
07/01/1954
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,765 0001604274478 1901030808530001
816
TAHLIM
PESERTA
08/08/1953
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,766 0001604274489 1901032105530001
820
MAS WARIN
PESERTA
03/11/1978
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,767 0001604274491 1901030505520001
829
SUTRISNO
PESERTA
05/05/1952
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,768 0001604274502 1901030107530023
833
SYAMSIR
PESERTA
07/01/1953
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,769 0001604274513 1901034505500002
859
ISNAIDAH
PESERTA
27/06/1982
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,770 0001604274524 1901034107540013
863
SUHARNI
PESERTA
07/01/1954
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,771 0001604274535 1901036404620001
869
ROSINA
PESERTA
24/04/1962
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,772 0001604274546 1901036811720001
905
HAZIAH
PESERTA
28/11/1972
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,773 0001604274557 1901031812060001
1090
IKBALLANI
PESERTA
18/12/2006
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,774 0001604274568 1901031204850003
1100
SELA SUNDARI
PESERTA
05/01/1998
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,775 0001604274579 1901031602620003
1118
SAMSUL
PESERTA
16/02/1962
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,776 0001604274581 1901034808670005
1118
HATIFAH
ISTRI
08/08/1967
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,777 0001604274592 1901031207470002
1132
RADI
PESERTA
12/07/1947
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,778 0001604274603 1901035108550002
1132
NURAINI
ISTRI
11/08/1955
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,779 0001604274614 1901030104100002
1160
TJHIN LAN SIT
PESERTA
10/03/1941
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 295 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,780 0001604274625 1901035401197003
1166
JENNYTA LAURENSYA JOHAN PESERTA
14/01/1997
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,781 0001604274636 1901031101013002
1170
RICKY DEWA SATRIA
PESERTA
01/11/2001
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,782 0001604274647 1901035408810003
1176
SIN TJHIANG
PESERTA
06/05/1944
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,783 0001604274658 1901030039350002
1177
NG DJIN MIN
PESERTA
03/07/1935
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,784 0001604274669 1901049044600001
1177
KIAM FUNG
ISTRI
04/09/1946
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,785 0001604274671 1901031212010001
1187
DEVIN FRANDY
PESERTA
12/12/2001
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,786 0001604274682 1901034065700001
1205
DJIOE TJIOE MOEK
PESERTA
24/06/1957
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,787 0001604274693 1901030606550002
1213
KONG BUN TJUNG
PESERTA
06/06/1955
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,788 0001604274704 1901030601590005
1277
Djung Than
PESERTA
06/01/1959
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,789 0001604274715 1901034911920001
1277
Arna
ANAK
09/11/1992
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
6,790 0001604274726 1901014101570002
1384
ALMANI
PESERTA
01/01/1957
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,791 0001604274737 1901011208850006
1384
TAUHID
ANAK
12/08/1985
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,792 0001604274748 1901010909550002
1386
MARJOHAN
PESERTA
09/09/1955
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,793 0001604274759 1901014211580006
1386
NURSIAH
ISTRI
02/11/1958
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,794 0001604274761 1901011000896003
1386
ADE YOLANDA SAPUTRA
ANAK
08/10/1996
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,795 0001604274772 1901014112580001
1389
ROSINI
PESERTA
12/01/1958
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,796 0001604274783 1901016408820001
1389
TINTIN S.
ANAK
24/08/1982
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,797 0001604274794 1901011808620006
1391
AHMAD RUSDIANTO
PESERTA
18/08/1962
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,798 0001604274805 1901014307700003
1391
YULYANI
ISTRI
07/03/1970
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,799 0001604274816 1901010206900002
1391
RUDI YUNIAR
ANAK
06/02/1990
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,800 0001604274827 1901016310930004
1391
OKTA DELVIANI
ANAK
23/06/1990
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,801 0001604274838 1901011711020002
1391
NOVIAR NEZAM
ANAK
17/11/2002
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,802 0001604274849 1901015506730002
1391
MELIANA RINA SARI
ANAK
15/05/1973
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 296 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,803 0001604274851 1901011001420001
1397
ABDUL HADI SALI
PESERTA
01/10/1942
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,804 0001604274862 1901014110520004
1397
SINA
ISTRI
10/01/1952
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,805 0001604274873 1901010709660004
1397
IBNU
ANAK
09/07/1986
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,806 0001604274884 1901010306590001
1409
SAIRI
PESERTA
06/03/1959
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,807 0001604274895 1901014305610001
1409
MURYANI
TAMBAHAN
05/03/1961
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,808 0001604274906 1901017012670001
1409
ZUBAIDAH
TAMBAHAN
30/12/1967
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,809 0001604274917 1901010805620002
1413
MULYADI
PESERTA
08/05/1992
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,810 0001604274928 1901012412900008
1413
HAIDIR
ISTRI
24/12/1990
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,811 0001604274939 1901012909920002
1413
SEPRIANDI
ANAK
29/09/1992
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,812 0001604274941 1901010809950002
1413
HERU ARDIANSYAH
ANAK
09/08/1995
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,813 0001604274952 1901011510402001
1413
HARI APRIZAL
ANAK
15/04/2002
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,814 0001604274963 1901012003660001
1420
SUHARLI
PESERTA
20/03/1966
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,815 0001604274974 1901014107690002
1420
KARTI
ISTRI
07/01/1969
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,816 0001604274985 1901012407010001
1420
YUDI AGUSTIRA
ANAK
24/07/2001
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,817 0001604274996 1901014107610025
1425
AMINAH
PESERTA
07/01/1961
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,818 0001604275007 1901014609870001
1425
MAYA
ANAK
09/06/1987
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,819 0001604275018 1901017103580002
1427
IDA YUNIAR
PESERTA
31/03/1958
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,820 0001604275029 1901012112780001
1427
M. DEFRI NAVIAR
ANAK
31/03/1958
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,821 0001604275031 1901010609510004
1427
M.SEPRIYADI NAVIAR
ANAK
21/12/1978
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,822 0001604275042 1901012402870001
1427
M. FERDIYANSYAH NAVIAR
ANAK
24/02/1987
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,823 0001604275053 1901010403530001
1440
HALERI AHAR
PESERTA
03/04/1953
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,824 0001604275064 1901011212970001
1440
KURNIA SANDI
ANAK
12/12/1997
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,825 0001604275075 1901010405990001
1440
SASTRA WIJAYA
ANAK
05/04/1999
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 297 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,826 0001604275086 1901014606520005
1444
SUKINI
PESERTA
11/12/1951
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,827 0001604275097 1901012609800052
1444
SUNANDAR
ISTRI
06/06/1952
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,828 0001604275108 1901012210900002
1444
NUR BAKRI
ANAK
26/09/1980
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,829 0001604275119 1901014709930004
1444
DEPIKA AMELISA
ANAK
09/07/1993
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,830 0001604275121 1901015307570001
1449
TARMINA
PESERTA
13/07/1957
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,831 0001604275187 1901016903550001
1457
TATTI ERLINA
PESERTA
29/03/1955
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,832 0001604275198 1901011007930004
1457
RIZALDI
ANAK
10/07/1993
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,833 0001604275209 1901014404750003
1462
SELVIA KASINA
PESERTA
04/04/1975
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,834 0001604275211 1901016010970006
1462
RANI OCTARIANI
ANAK
20/10/1997
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,835 0001604275222 1901012511060003
1462
MUHAMAD NOVAL BAROKA
ANAK
25/11/2006
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,836 0001604275233 1901012108670002
1465
ALI DJOYO
PESERTA
21/08/1967
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,837 0001604275244 1901016802610006
1465
IIN INDAHWATI
ISTRI
28/02/1961
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,838 0001604275255 1901013005910005
1465
INDRA PRATAMA
ANAK
30/05/1991
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,839 0001604275266 1901012410920005
1465
INSYAH MAULANA
ANAK
24/10/1992
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,840 0001604275277 1901014905990003
1465
RIMA ANJLI KADINATA
ANAK
09/05/1999
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,841 0001604275288 1901015012690004
1470
ANI
PESERTA
10/12/1969
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,842 0001604275299 1901011211950001
1470
NOPIANTO
ANAK
12/11/1995
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,843 0001604275301 1901010906970002
1470
SUPRIANTO
ANAK
09/06/1997
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,844 0001604275312 1901011106990002
1470
SUMBERIANTO
ANAK
11/06/1999
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,845 0001604275323 1901014704020006
1470
SUSIANTI
ANAK
07/04/2002
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,846 0001604275334 1901011119400001
1475
ZUBIR R. ROBANGI
PESERTA
11/11/1940
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,847 0001604275345 1901014107450006
1475
MAINAH
ISTRI
01/07/1946
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,848 0001604275356 1901010406890009
1475
FERLIANSYAH
ANAK
04/06/1989
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 298 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,849 0001604275367 1901011311390001
1479
MARYADHI
PESERTA
13/11/1939
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,850 0001604275378 1901014502510001
1479
MIRNAWATI
ISTRI
05/02/1951
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,851 0001604275389 1901015311750001
1479
WIWIET NOVIANINGSIH
ANAK
13/11/1975
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,852 0001604275391 1901010596490002
1482
ARMIN
PESERTA
05/06/1949
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,853 0001604275402 1901014203960001
1482
AGIT
ISTRI
02/03/1960
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,854 0001604275413 1901014804820002
1482
TIRA KUSUMAWATI
ANAK
08/04/1982
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,855 0001604275424 1901014505880006
1482
RIKANA
ANAK
06/05/1986
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,856 0001604275435 1901010903870001
1482
ALFIAN
ANAK
09/03/1987
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,857 0001604275446 1901010604500006
1487
IMAN SUKIRMAN
PESERTA
06/04/1950
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,858 0001604275457 1901017112500007
1487
SUHANA
ISTRI
31/12/1950
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,859 0001604275468 1901012507910003
1487
DEDE YULIZAR
ANAK
25/07/1991
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,860 0001604275479 1901016819590001
1490
ULFAH
PESERTA
28/01/1959
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,861 0001604275481 1901015505550001
1492
ZAIDAH
PESERTA
15/05/1955
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,862 0001604275492 1901010108860002
1492
SAPRAN
ANAK
01/09/1986
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,863 0001604275503 1901010609530003
1494
RUSLAN IDRUS
PESERTA
06/09/1953
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,864 0001604275514 1901014901955006
1494
SYAHZINTENIPON
ISTRI
09/06/1955
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,865 0001604275525 1901010109660003
1494
ZALMAN
ANAK
01/09/1986
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,866 0001604275536 1901015407410001
1497
TJI AMIS
PESERTA
14/07/1941
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,867 0001604275547 1901015110691003
1502
BONG KHIUN SIN
PESERTA
11/10/1962
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,868 0001604275558 1901010108500007
1503
M.ALI SUPRIYADI
PESERTA
01/08/1950
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,869 0001604275569 1901016309580003
1503
RR.SRI WAHYU ERLINAWATI
ISTRI
23/09/1958
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,870 0001879460897 1901014103010009
1503
Sheylla Dea Sabrina
ANAK
03/01/2001
KENANGA
01/02/2015
AKTIF
19,225
24/08/2015
6,871 0001879461336 1901016910040007
1503
Chiydy Rahayu Ningsih
ANAK
29/10/2004
KENANGA
01/02/2015
AKTIF
19,225
24/08/2015
12/2/15 3:16 PM
Page 299 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,872 0001879462451 1901011902060006
1503
Sukma Darma Adi Saputra
ANAK
19/02/2005
KENANGA
01/02/2015
AKTIF
19,225
24/08/2015
6,873 0001604275571 1901011212620007
1506
ALFENO
PESERTA
12/12/1962
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,874 0001604275582 1901014106640005
1506
YUNIAR
ISTRI
01/06/1964
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,875 0001604275593 1901012009000002
1506
MICTA ILHUDA
ANAK
20/09/2000
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,876 0001604275604 1901011702630003
1510
LO KHIN TJO
PESERTA
17/02/1963
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,877 0001604275615 1901014805800007
1514
EFFIE
PESERTA
08/05/1980
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,878 0001604275626 1901012102860007
1514
WELLI SETIAWAN
ANAK
21/02/1986
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,879 0001604275637 1901015604670004
1518
DIAH FITRIJANA
PESERTA
16/04/1967
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,880 0001604275648 1901013105530003
1520
SUKARDI
PESERTA
31/05/1953
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,881 0001604275659 1901016002550003
1520
MASMANA
ISTRI
31/05/1953
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,882 0001604275661 1901015609940003
1520
JULAIHA
ANAK
16/09/1994
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,883 0001604275672 1901014404658002
1523
LO ASUN
PESERTA
04/04/1958
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,884 0001604275683 1901010508300001
1524
B. SUJAI
PESERTA
05/08/1930
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,885 0001604275694 1901015708550001
1524
POPON FATIMAH
ISTRI
17/08/1955
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,886 0001604275705 1901012001770002
1524
IWAN SETIAWAN
ANAK
20/01/1977
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,887 0001604275716 1901011508940001
1524
ANHAR YANA
ANAK
15/08/1994
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,888 0001604275727 1901016308540002
1528
TJOENG KIM WAN
PESERTA
23/08/1954
dr. ANDY TANOR
01/02/2015
AKTIF
19,225
24/01/2015
6,889 0001604275738 1901015412830001
1528
LYDIA PURWANTI
ANAK
14/12/1983
dr. ANDY TANOR
01/02/2015
AKTIF
19,225
24/01/2015
6,890 0001604275749 1901014808860003
1531
THU RINI
PESERTA
08/08/1986
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,891 0001604275751 1901011506060003
1531
RIKARDO
ANAK
15/06/2006
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,892 0001604275762 1901011175380002
1533
BOEN KHIE BOEI
PESERTA
17/05/1938
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,893 0001604275773 1901017006520001
1538
TJIU NYUN NIT
PESERTA
30/05/1952
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,894 0001604275784 1901015709450003
1539
ROMLAH
PESERTA
17/05/1945
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 300 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,895 0001604275795 1901012401750004
1539
HERMANTO
ISTRI
24/01/1975
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,896 0001604275806 1901015107430002
1545
BOEN MOEK DJIM
PESERTA
11/07/1943
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,897 0001604275817 1901015110900002
1552
VENITA
PESERTA
21/10/1990
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,898 0001604275828 1901010701250002
1554
LOE MOENG SAN
PESERTA
01/07/1926
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,899 0001604275839 1901011402500005
1554
LOE SOEI PO
ISTRI
14/02/1950
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,900 0001604275841 1901012708700005
1559
KHAMSAH JACKARYA
PESERTA
27/08/1970
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,901 0001604275852 1901015109770002
1559
FITTRIYANI
ISTRI
09/11/1977
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,902 0001604275863 1901012207680004
1561
WANDI
PESERTA
22/07/1968
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,903 0001604275874 1901015807720000
1561
FAJRIATI
ISTRI
18/07/1972
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
6,904 0001604275885 1901014808950007
1561
YURIKA ARINDA
ANAK
08/08/1995
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,905 0001604275896 1901012120060001
1561
RAIHAN DWI OCTO

RAMADHAN
ANAK
10/02/2006
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,906 0001604275907 1901010803730008
1561
DEDIH
TAMBAHAN
03/08/1973
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,907 0001604275918 1901014510510004
1566
LIE ANA
PESERTA
10/05/1951
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,908 0001604275929 1901015011960004
1571
EVI TAMALA
PESERTA
11/10/1996
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,909 0001604275931 1901017008980003
1571
LENA ASTUTI
TAMBAHAN
30/08/1998
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,910 0001604275942 1901011806153004
1573
TAMRIN TAHZAR
PESERTA
18/06/1953
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,911 0001604275953 1671122010850006
1576
JUNAIDI EFFENDI
PESERTA
20/10/1985
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,912 0001604275964 1901015308920003
1576
ASNAWATI
ISTRI
13/08/1992
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,913 0001604275975 1671124601090004
1576
TAMARA JUSNA
ANAK
01/06/2009
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,914 0001604275986 1901016805140004
1576
ZALIFAH HURAIRAH
ANAK
28/05/2014
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,915 0001604275997 1901012107880003
1580
REVIANDY
PESERTA
21/07/1988
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,916 0001604276008 1901010519820005
1582
TOTO JUANDA
PESERTA
01/05/1982
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,917 0001604276019 1901054101910003
1582
SARTIKA
ISTRI
01/01/1991
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 301 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,918 0001604276021 1901011006050001
1582
AGIS ADITYA PRATAMA
ANAK
06/10/2005
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,919 0001604276032 1901015610080001
1582
AYU RIANDA AGISTA
ANAK
16/10/2008
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,920 0001604276043 1901012312700001
1588
M. ANSHORIE
PESERTA
23/12/1970
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,921 0001604276054 1901016819800001
1588
HENI ARTIATI
ISTRI
28/09/1980
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,922 0001604276065 1901016004970008
1588
BUNGA KURNIASARI
ANAK
20/04/1997
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,923 0001604276076 1901012406990008
1588
M. ANDHIKA MAULANA
ANAK
24/06/1999
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,924 0001604276087 1901016002020002
1588
DHEA NATASYA PUTRI
ANAK
20/02/2002
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,925 0001604276098 1901012506090004
1588
M ADRIAN SAPUTRA
ANAK
25/08/2009
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,926 0001604276109 1901010320110004
1588
M. RADJA RAFAEL
ANAK
03/01/2011
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,927 0001604276111 1901010703940004
1596
REVANDY
PESERTA
21/03/1990
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,928 0001604276122 1901010101740009
1597
HERLAN
PESERTA
01/01/1968
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,929 0001604276133 1901014509740003
1597
KASMAWATI
ISTRI
09/05/1974
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,930 0001604276144 1901014903950004
1597
YUYU HERNAWATI
ANAK
03/09/1995
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,931 0001604276155 1901011301020003
1597
BAMBANG MAULANA
ANAK
13/01/2002
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,932 0001604276166 1901012705700007
1601
MISKAR
PESERTA
27/05/1970
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,933 0001604276177 1901011904950010
1601
M.SYAIRI
ANAK
19/04/1995
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,934 0001604276188 1901016101010003
1601
RIZKI DANA YANTI
ANAK
21/01/2001
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,935 0001604276199 1901011112870004
1604
SAHDAN
PESERTA
12/11/1987
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,936 0001604276201 1905057189860001
1604
MARINI
ISTRI
31/08/1986
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,937 0001604276212 1901015707120003
1604
AVIKA RAMDHANI
ANAK
17/07/2012
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
6,938 0001604276223 1901040505450002
1615
JAKARIA
PESERTA
05/05/1945
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,939 0001604276234 1901044203640002
1615
ROHANA
ISTRI
03/02/1964
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,940 0001604276245 1901040702830001
1617
JOHAN
PESERTA
02/07/1983
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 302 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,941 0001604276256 1901044107880108
1617
SAUYAH
ISTRI
07/01/1988
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,942 0001604276267 1901041212100001
1617
ANDREYADI
ANAK
12/12/2010
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,943 0001604276278 1901040107350013
1620
AJIS
PESERTA
01/07/1935
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,944 0001604276289 1901044107370057
1620
HANISA
ISTRI
01/07/1937
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,945 0001604276291 1901041005570003
1622
ROBANI
PESERTA
10/05/1957
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,946 0001604276302 1901044903660001
1622
MISNAH
ISTRI
09/03/1966
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,947 0001604276313 1901042605860001
1624
RIZAL EFENDI
PESERTA
26/05/1986
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,948 0001604276324 1901044107840049
1624
SAPARIDAH
ISTRI
01/07/1984
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,949 0001604276335 1901046210050001
1624
AYU LESTARI
ANAK
22/10/2005
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,950 0001604276346 1901041203830005
1627
IRPANDI
PESERTA
12/03/1983
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,951 0001604276357 1901046601860003
1627
ASNAH
ANAK
26/01/2010
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,952 0001604276368 1901046411100001
1627
MELANY PUTIA
ANAK
24/11/2010
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,953 0001604276379 1901041210820001
1630
SUADI
PESERTA
12/10/1982
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,954 0001604276381 1901045205850002
1630
ROSNAH
ISTRI
12/05/1986
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,955 0001604276392 1901042103060001
1630
ROSLAN
ANAK
21/03/2006
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,956 0001604276403 1901041608910005
1633
HANDIKO
PESERTA
16/08/1991
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,957 0001604276414 1901044403930003
1633
MARYATI
ANAK
04/03/1993
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,958 0001604276425 1901041902820003
1635
SYAHRIAL
PESERTA
19/02/1982
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,959 0001604276436 1901044705900006
1635
SOPIAH
ISTRI
07/05/1990
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,960 0001604276447 1901045801100001
1635
ALMAS PUTRIANSYAH
ANAK
18/01/2010
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,961 0001604276458 1901042202800001
1638
GAHRIAL
PESERTA
22/02/1980
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,962 0001604276469 1901044909840003
1638
AINI
ISTRI
09/09/1984
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,963 0001604276471 1901040205040003
1638
FADLI
ANAK
02/05/2004
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 303 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,964 0001604276482 1901044708090001
1638
WANTI
ANAK
07/08/2009
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,965 0001604276493 1901041505550001
1642
NASIDI
PESERTA
15/05/1955
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,966 0001604276504 1901044308600003
1642
KASTINI
ISTRI
03/08/1960
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,967 0001604276515 1901044305990004
1642
ISNENI NEKA INDRIANI
ANAK
03/05/1999
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,968 0001604276526 1901040107610040
1645
AMRI
PESERTA
01/07/1961
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,969 0001604276537 1901040701840030
1645
SUMARTONI
ISTRI
07/01/1984
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,970 0001604276548 1901041510950002
1645
RENDI GUNAWAN
ANAK
16/10/1995
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,971 0001604276559 1901042302030002
1645
FERDIANSYAH
ANAK
23/02/2003
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,972 0001604276561 1901045202060002
1645
TITIN
ANAK
12/02/2006
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,973 0001604276572 1901040505670003
1650
AHMAD SOPIAN
PESERTA
05/05/1967
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,974 0001604276583 1901046808690003
1650
SUWARIYAH
ISTRI
28/08/1969
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,975 0001604276594 1901041006890002
1650
AHMAD FAUZI
ANAK
06/10/1989
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,976 0001604276605 1901040406940003
1650
AHMAD IQBAL
ANAK
06/04/1994
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,977 0001604276616 1901045006980004
1650
PUTRI YUNIAR
ANAK
06/10/1998
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,978 0001604276627 1901045411010004
1650
YUNILITA HANUM
ANAK
11/10/2001
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,979 0001604276638 1901044702120001
1650
MAULIDA SALSABILA
ANAK
02/07/2012
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,980 0001604276649 1901044017000001
1657
INDUN
PESERTA
01/04/1970
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,981 0001604276651 1901042506950001
1657
JONI ISKANDAR
ANAK
25/06/1995
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,982 0001604276662 1901046011010001
1657
NOVITA DEWI
ANAK
20/11/2011
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,983 0001604276673 1901043006830002
1660
RIDUAN
PESERTA
30/06/1983
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,984 0001604276684 1901044106850002
1660
SURYA
ISTRI
06/01/1985
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,985 0001604276695 1901044704090001
1660
APRILLAZI
ANAK
04/07/2009
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,986 0001604276706 1901041510450001
1667
SUHAIMI
PESERTA
15/10/1945
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 304 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
6,987 0001604276717 1901044110580001
1667
SUNAINI
ISTRI
07/01/1958
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,988 0001604276728 1901041010900005
1667
BUJANG IRAWAN
ANAK
10/10/1990
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,989 0001604276739 1901045003960001
1667
MURNI
ANAK
03/10/1996
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,990 0001604276741 1901041711980001
1667
NOPRIADI
ANAK
17/11/1998
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,991 0001604276752 1901047101000001
1667
FITRIANI
ANAK
31/01/2000
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,992 0001604276763 1901040701770033
1673
ASANAH
PESERTA
07/01/1978
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,993 0001604276774 1901045705030003
1673
HERZA YUNIAR
ANAK
17/05/2003
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,994 0001604276785 1901040806600001
1675
SA'AR
PESERTA
06/08/1960
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,995 0001604276796 1901044704620002
1675
JUM'AH
ISTRI
04/07/1962
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,996 0001604276807 1901040812910001
1675
JURI
ANAK
12/08/1991
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,997 0001604276818 1901040508480001
1678
SAHRUDIN
PESERTA
08/05/1948
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,998 0001604276829 1901040602430001
1679
ARAS
PESERTA
02/06/1943
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
6,999 0001604276831 1901044507450002
1679
NAH
ISTRI
07/05/1945
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,000 0001604276842 1901041909920001
1682
IMAM MAHDI
PESERTA
19/09/1992
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,001 0001604276853 1901040508940001
1682
M.BURHANUDIN
ANAK
08/05/1994
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,002 0001604276864 1901046108990002
1682
LIA ALFIANA AZIZAH
ANAK
21/08/1999
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,003 0001604276875 1901045508130002
1685
LINI AZKIYA
PESERTA
15/08/2013
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,004 0001604276886 1901040812110002
1687
DIAZ NAIL BARQI
PESERTA
03/12/2011
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,005 0001604276897 1901041708110001
1688
HASBIYULLAH
PESERTA
17/08/2011
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,006 0001604276908 1901045503130001
1689
ALLIA AZURA
PESERTA
15/03/2013
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,007 0001604276919 1901012001800007
1690
SUGIRI
PESERTA
20/01/1980
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,008 0001604276921 1901015208870006
1690
ALHIKMAH
ISTRI
12/08/1987
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,009 0001604276932 1901012007050004
1690
KIKI ADITIA
ANAK
20/07/2006
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 305 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,010 0001604276943 1901042003850002
1693
ASANO
PESERTA
10/08/1985
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,011 0001604276954 1901044808870006
1693
GUSTINA
ISTRI
08/08/1987
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,012 0001604276965 1901042003850003
1693
YUSUF MUJARROBI
ANAK
30/03/2012
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,013 0001604276976 1901042909870003
1697
KUNTUR WINARDI
PESERTA
29/09/1987
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,014 0001604276987 1901045806900002
1697
SRI JUARTI
ISTRI
18/06/1990
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,015 0001604276998 1901044606120001
1697
FATIMAH AZZAHHRA
ANAK
06/06/2012
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,016 0001604277009 1901041001800003
1699
SAMSUL BAHRI
PESERTA
01/01/1980
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,017 0001604277011 1901045210820003
1699
ROAINA
ISTRI
12/10/1982
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,018 0001604277022 1901046112010001
1699
NURINDAH
ANAK
21/12/2001
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,019 0001604277033 1901045205060006
1699
SINTA KARLISA
ANAK
12/05/2006
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,020 0001604277044 1901045207110003
1699
SAKINAH
ANAK
12/07/2011
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,021 0001604277055 1901041604660002
1704
A.NORPIN
PESERTA
16/04/1968
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,022 0001604277066 1901044107729088
1704
JAMIAH
ISTRI
01/07/1972
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,023 0001604277077 1901042309900002
1704
AGUS SALIM
ANAK
23/09/1990
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,024 0001604277088 1901040501950004
1704
HASBULLAH
ANAK
05/01/1995
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,025 0001604277099 1901040909970003
1704
ASEP MA?RUP
ANAK
09/09/1997
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,026 0001604277101 1901044301050002
1704
MELSHANDA PUTRI
ANAK
03/01/2005
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,027 0001604277112 1901041612060002
1704
HASAN
ANAK
16/12/1980
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,028 0001604277123 1901040103800142
1704
SAWAL
TAMBAHAN
01/07/1980
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,029 0001604277134 1901042606830001
1712
SUHANDA
PESERTA
26/06/1983
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,030 0001604277145 1901044606870005
1712
PARIDA
ISTRI
06/06/1987
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,031 0001604277156 1901041306080001
1712
BAAIM AHMAD JUMADIL
ANAK
15/06/2008
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,032 0001604277167 1901044805130001
1712
RADI DAMRILANI
ANAK
08/05/2013
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 306 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,033 0001604277178 1901040605760006
1716
ALPIAN
PESERTA
08/05/1976
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,034 0001604277189 1901046406740001
1716
UMI KALSUM
ISTRI
24/08/1974
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,035 0001604277191 1901042207050004
1716
ASRAR AL ARIFIN
ANAK
22/07/2005
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,036 0001604277202 1901044103590001
1719
ASIAH
PESERTA
01/03/1959
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,037 0001604277213 1901046408970001
1719
KASMAWATI
ANAK
24/08/1997
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,038 0001604277224 1901040406670001
1721
NASRODIN
PESERTA
04/07/1967
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,039 0001604277235 1901045706750001
1721
ANITA
ISTRI
17/06/1974
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,040 0001604277246 1901045302980004
1721
INA HUDAYANTI
ANAK
13/02/1998
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,041 0001604277257 1901044504000002
1721
NURLENA
ANAK
20/03/2000
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,042 0001604277268 1901045204020002
1721
IRDA YANTI
ANAK
08/01/2002
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,043 0001604277279 1901046411080001
1721
SAKINAH
ANAK
24/11/2008
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,044 0001604277281 1901041001630001
1727
HAIRUL SALEH
PESERTA
10/01/1963
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,045 0001604277292 1901046510700001
1727
ZURILATI
ISTRI
11/07/1970
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,046 0001604277303 1901041002950002
1727
AHMAD EFENDI
ANAK
10/02/1996
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,047 0001604277314 1901046506000001
1727
NURUL ZAKIAH
ANAK
25/06/2000
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,048 0001604277325 1901041001040003
1727
ARIEF NANDO
ANAK
10/01/2004
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,049 0001604277336 1901041507670006
1732
HASBULLAH
PESERTA
15/07/1967
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,050 0001604277347 1901044610770001
1732
SUZANA
ISTRI
06/10/1977
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,051 0001604277358 1901046802940003
1732
NUZUL KURNIA
ANAK
28/02/1994
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,052 0001604277369 1901044510980004
1732
SARINI
ANAK
09/10/1998
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,053 0001604277371 1901044109050003
1732
HESTI MARDIAH
ANAK
01/09/2005
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,054 0001604277382 1901040510100001
1732
MUHAMAD HABIBI
ANAK
05/10/2010
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,055 0001604277393 1901041203690002
1739
SAMSUMIN
PESERTA
12/03/1969
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 307 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,056 0001604277404 1901046805750001
1739
PARIDA WATI
ISTRI
28/05/1975
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,057 0001604277415 1901045907940003
1739
ASIH IMAN SARI
ANAK
19/07/1994
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,058 0001604277426 1901045312950003
1739
RIA SUCI YANI
ANAK
13/12/1995
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,059 0001604277437 1901040803970001
1739
ANUGRAH BUDIANA
ANAK
08/03/1997
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,060 0001604277448 1901045404010003
1739
RINDIANI
ANAK
14/04/2001
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,061 0001604277459 1901044904050003
1739
CICI RAHMAWATI
ANAK
04/09/2005
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,062 0001604277461 1901045209110001
1739
MADINA
ANAK
12/09/2011
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,063 0001604277472 1901044801620001
1747
ZUBIAN
PESERTA
08/01/1962
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,064 0001604277483 1901040503870001
1747
ABDURRAHMAN
ANAK
05/03/1987
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,065 0001604277505 1901044709890002
1747
MARYAM
ANAK
07/09/1989
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,066 0001604277516 1901042104910004
1747
AHMAD TOHIR
ANAK
21/04/1991
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,067 0001604277527 1901041106950002
1747
M. SOLIH
ANAK
11/06/1955
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,068 0001604277538 1901046107980001
1747
KARISMA
ANAK
21/07/1998
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,069 0001604277549 1904031212850005
1754
HERRI
PESERTA
12/12/1985
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,070 0001604277551 1901046801910001
1754
JAMALIAH
ISTRI
28/01/1991
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,071 0001604277562 1901044101110001
1754
JANIATU BARIAH
ANAK
01/01/2011
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,072 0001604277573 1901041305850007
1757
RIKI
PESERTA
13/05/1985
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,073 0001604277584 1901045207890005
1757
SAROPAH
ISTRI
12/07/1989
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,074 0001604277595 1901041010100001
1757
FARISKI
ANAK
10/10/2010
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,075 0001604277606 1901040507870001
1760
RENDI
PESERTA
07/07/1987
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,076 0001604277617 1901044611880001
1760
SUMIATI
ISTRI
06/11/1988
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,077 0001604277628 1901040703090001
1760
NUHRI
ANAK
07/03/2009
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,078 0001604277639 1901041609660001
1763
RUSMAN
PESERTA
16/09/1966
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 308 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,079 0001604277641 1901044105700002
1763
HASMIAH
ISTRI
21/05/1970
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,080 0001604277652 1901044707970001
1763
AYU RISDINA WATI
ANAK
07/07/1997
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,081 0001604277663 1901046609090001
1763
SETIA NINGSIH
ANAK
26/09/2009
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,082 0001604277674 1901041209790001
1767
YANTO SAPRIYANTO
PESERTA
12/09/1979
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,083 0001604277685 1901044102860004
1767
HERLIKA
ISTRI
01/02/1986
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,084 0001604277696 1901044504060002
1767
SITI MULYANI
ANAK
05/04/2006
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,085 0001604277707 1901040807600001
1770
SUDARTO
PESERTA
08/07/1960
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,086 0001604277718 1901044209700002
1770
JAMA?ATI
ISTRI
02/09/1970
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,087 0001604277729 1901040412860001
1770
ERWADI
ANAK
04/12/1986
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,088 0001604277731 1901046008920001
1770
SAMSUL
ANAK
06/12/1988
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,089 0001604277742 1901040812950002
1770
BURHAN
ANAK
08/12/1995
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,090 0001604277753 1901040504860001
1775
MULYADI
PESERTA
05/04/1986
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,091 0001604277764 1901043611880006
1775
MAINAH
ISTRI
21/11/1988
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,092 0001604277775 1901045401120002
1775
AFLAHUN NISA
ANAK
14/01/2012
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,093 0001604277786 1901041203850004
1778
SAPUTRA
PESERTA
12/03/1985
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,094 0001604277797 1901044709890003
1778
SAMSIAH
ISTRI
07/09/1989
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,095 0001604277808 1901045003110001
1778
CINTA
ANAK
10/03/2011
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,096 0001604277819 1901040608670001
1781
TAMRI
PESERTA
06/08/1967
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,097 0001604277821 1901044411700001
1781
TITIN WARDIANTY
ISTRI
04/11/1970
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,098 0001604277832 1901044802920004
1781
ANDINI TIARA
ANAK
08/07/1992
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,099 0001604277843 1901042211940001
1781
YUDI PRATAMA
ANAK
22/11/1994
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,100 0001604277854 1901040510920002
1781
DANILDI
ANAK
05/10/1997
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,101 0001604277865 1901040312050003
1781
ANGGA ARDIANSYAH
ANAK
03/12/2005
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 309 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,102 0001604277876 1901041511100002
1781
IDHAM
ANAK
15/11/2010
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,103 0001604277887 1901040502600001
1788
USMAN
PESERTA
05/02/1960
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,104 0001604277898 1901040509730002
1788
RUSTINAWATI
ISTRI
05/09/1973
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,105 0001604277909 1901042004900001
1788
ZAITUN
ANAK
30/04/1990
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,106 0001604277911 1901042708950002
1788
MUHAMMAD ZIKRI
ANAK
27/08/1995
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,107 0001604277922 1901042310960001
1788
ANITA
ANAK
23/10/1996
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,108 0001604277933 1901041412990003
1788
MUHAMMAD RONI
ANAK
14/12/1999
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,109 0001604277944 1901045506050002
1788
MULIAWATI
ANAK
15/06/2005
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,110 0001604277955 1901042609660002
1795
AMRI PIRMANSYAH
PESERTA
26/09/1966
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,111 0001604277966 1901045203730001
1795
ROSINAH
ISTRI
12/03/1973
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,112 0001604277977 1901041108950001
1795
IMAM MAULANA
ANAK
11/08/1955
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,113 0001604277988 1901045402970001
1795
FITRI FEBRIANA
ANAK
14/02/1997
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,114 0001604277999 1901041811980003
1795
TOYAN
ANAK
18/11/1998
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,115 0001604278001 1901040505040003
1795
FARIZAN ZAKARYA
ANAK
05/05/2004
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,116 0001604278012 1901040805100001
1795
MUHAMMAD FAUZAN
ANAK
08/05/2010
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,117 0001604278023 1901040711720002
1802
HANDANI
PESERTA
07/11/1972
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,118 0001604278034 1901044509760001
1802
NONANI
ISTRI
08/05/1976
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,119 0001604278045 1901041002940001
1802
BUSTARI
ANAK
10/02/1994
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,120 0001604278056 1901040808960001
1802
SYAHRUL ADRI
ANAK
08/08/1996
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,121 0001604278067 1901044807980001
1802
YUTIA
ANAK
08/07/1998
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,122 0001604278078 1901041619020002
1802
SYAHRIL
ANAK
16/09/2002
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,123 0001604278089 1901040202800002
1808
SUHARDI
PESERTA
02/02/1980
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,124 0001604278091 1901041209560001
1811
AHMAD
PESERTA
12/04/1956
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 310 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,125 0001604278102 1901044507630001
1811
ASIAH
ISTRI
05/07/1963
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,126 0001604278113 1901041011850003
1811
ZAKARIA
ANAK
10/11/1985
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,127 0001604278124 1901040503900003
1811
ZUL KARNAIN
ANAK
05/03/1990
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,128 0001604278135 1901042207940001
1811
ANDI
ANAK
22/07/1994
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,129 0001604278146 1901041010950003
1811
RIZAL
ANAK
10/10/1995
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,130 0001604278157 1901040703970002
1811
PAHMI
ANAK
07/03/1997
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,131 0001604278168 1901045404980001
1811
PATIMAH
ANAK
14/04/1997
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,132 0001604278179 1901046311030002
1811
LAILATUL KHOIRIAH
ANAK
23/11/2003
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,133 0001604278181 1901041511050004
1811
IKBAL
ANAK
15/11/2005
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,134 0001604278192 1901040107820001
1821
WARISTO
PESERTA
12/05/1980
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,135 0001604278203 1901045203850002
1821
AIDA KARISMA
ISTRI
25/09/1984
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,136 0001604278214 1901040712030002
1821
ANJAS PRANOTO
ANAK
07/12/2003
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,137 0001604278225 1901044910090001
1821
DEVI OKTAVIANA
ANAK
09/10/2009
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,138 0001604278236 1901042404950003
1821
NORMA
ANAK
24/04/1995
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,139 0001604278247 1901042707740003
1826
HELMI
PESERTA
27/07/1974
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,140 0001604278258 1901046004850001
1826
NURLIA
ISTRI
20/04/1985
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,141 0001604278269 1901042711990003
1826
MARWATI
ANAK
27/11/1999
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,142 0001604278271 1901040105000001
1826
FITRIA
ANAK
05/01/2000
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,143 0001604278282 1901046908060002
1826
MASITOH
ANAK
29/08/2006
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,144 0001604278293 1901040706730002
1831
IBROHIM
PESERTA
07/06/1973
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,145 0001604278304 1901045712020002
1831
DELIPA RAHMAWATI
ANAK
17/12/2002
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,146 0001604278315 1901040607050004
1831
ROBUAN QORI
ANAK
06/07/2005
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,147 0001604278326 1901044110100001
1831
RANI SAFITRI
ANAK
01/10/2010
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 311 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,148 0001604278337 1901045006400001
1837
OMSAH
PESERTA
01/01/1940
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,149 0001604278348 1901040906110001
1838
FARIS GOZALI
PESERTA
09/06/2011
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,150 0001604278359 1901040701700018
1839
SUMITRA
PESERTA
07/01/1970
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,151 0001604278361 1901040404990002
1841
AHMAD DUMROH
PESERTA
04/04/1999
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,152 0001604278372 1904030107810115
1842
DIDI DARMADI
PESERTA
01/07/1981
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,153 0001604278383 1904034601850001
1842
PURWATI
ISTRI
01/01/1985
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,154 0001604278394 1904034306040001
1842
RINI DONA PEBRIANTI
ANAK
03/06/2004
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,155 0001604278405 1904030407090001
1842
MUHAMAD DENIS
ANAK
04/07/2009
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,156 0001604278416 1901044859120002
1846
RUDI
PESERTA
12/12/1988
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,157 0001604278427 1901041813720003
1846
NITA
ISTRI
10/05/1994
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,158 0001604278438 1901044859120007
1846
KURNIAWAN
ANAK
18/05/2011
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,159 0001604278449 1901040610890001
1849
IBNU HAJAR
PESERTA
06/10/1989
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,160 0001604278451 1901046006880002
1849
FITRI
ISTRI
20/06/1988
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,161 0001604278462 1901044708080001
1849
DEWI
ANAK
07/08/2008
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,162 0001604278473 1901044710130003
1852
GISKA ALINGGA
PESERTA
07/10/2013
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,163 0001604278484 1406091003770003
1853
SURYAN TONI
PESERTA
10/03/1977
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,164 0001604278495 1406098403810001
1853
MISNI
ISTRI
03/08/1981
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,165 0001604278506 1406095003000011
1853
YUSNI NURANUM
ANAK
03/10/2000
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,166 0001604278517 1406091304130001
1853
MELA SAPITRI
ANAK
08/01/2004
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,167 0001604278528 1406094108040004
1853
ALIPTAMIR MAULANA
ANAK
13/04/2013
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,168 0001604278539 1901042408700003
1858
RIZANI
PESERTA
24/08/1970
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,169 0001604278541 1901045005720003
1858
LILIS LINARI
ISTRI
10/05/1972
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,170 0001604278552 1901040809900006
1858
SUPRIYADI
ANAK
08/09/1990
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 312 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,171 0001604278563 1901044206980001
1858
SUSI SUGIANTI
ANAK
11/01/1994
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,172 0001604278574 1901040311990003
1858
HAZARI AHMAD
ANAK
03/11/1999
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,173 0001604278585 1901041202070003
1858
ZIKRULLAH
ANAK
12/12/2007
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,174 0001604278596 1905011908620002
1864
ROZALI
PESERTA
19/06/1962
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,175 0001604278607 1905012807720001
1864
SOSO?AH
ISTRI
08/07/1970
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,176 0001604278618 1905015302980002
1864
SITI FAUZIAH
ANAK
13/02/1998
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,177 0001604278629 1905011003000001
1864
IBNU HAJAR
ANAK
10/03/2000
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,178 0001604278631 1905011201070002
1864
AIDIL ZIKRI
ANAK
12/01/2007
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,179 0001604278642 1901042909860003
1869
SAHRUL RONI
PESERTA
29/09/1986
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,180 0001604278653 1901046804910004
1869
FITRI YANI
ISTRI
28/04/1991
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,181 0001604278664 1901040210110002
1869
FARDAN RONI
ANAK
02/10/2007
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,182 0001604278675 1901041308790001
1872
NASSPI
PESERTA
13/08/1979
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,183 0001604278686 1901045603850004
1872
ICA ELISA
ISTRI
16/03/1985
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,184 0001604278697 1901044304030002
1872
RISTINA APRICA
ANAK
03/04/2003
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,185 0001604278708 1901045510070005
1872
FITRI ANRIANI
ANAK
15/10/2007
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,186 0001604278719 1901041811110002
1872
SATRIA SABDI
ANAK
19/12/2011
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,187 0001604278721 1901040609660003
1877
SUGIAN
PESERTA
06/09/1966
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,188 0001604278732 1901044706690002
1877
HAYATI
ISTRI
07/08/1969
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,189 0001604278743 1901044507940001
1877
PARIDA ARYANI
ANAK
05/07/1994
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,190 0001604278754 1901045005960001
1877
YULITA
ANAK
10/05/1996
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,191 0001604278765 1901042103980003
1877
KURNIAWAN
ANAK
21/03/1998
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,192 0001604278776 1901040505000003
1877
APRIYADI
ANAK
06/05/2000
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,193 0001604278787 1901040707030003
1877
RIDOPADLI
ANAK
07/07/2003
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 313 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,194 0001604278798 1901042307820003
1884
ASWANDI
PESERTA
23/07/1982
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,195 0001604278809 1901045707890006
1884
ZULPAIZAH
ISTRI
17/07/1989
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,196 0001604278811 1901042911600003
1884
GUNTUR SAMUDRA
ANAK
29/11/2000
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,197 0001604278822 1901044202130005
1884
ENGJELIA
ANAK
02/02/2013
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,198 0001604278833 1901040203850001
1888
MUHAMAD ALBI
PESERTA
03/02/1985
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,199 0001604278844 1901045711870001
1888
NURUL HAYATI
ISTRI
17/11/1987
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,200 0001604278855 1901044707110001
1888
KAEYLA ATTAPSI
ANAK
07/02/2011
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,201 0001604278866 1901041212870009
1891
MUHAMAD AZIRI
PESERTA
12/12/1987
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,202 0001604278877 1901044705910004
1891
HOTIJAH
ISTRI
07/05/1991
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,203 0001604278888 1901041902130004
1891
DARUL KUTNI
ANAK
19/02/2013
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,204 0001604278899 1901040402660003
1894
ABU
PESERTA
04/02/1966
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,205 0001604278901 1901044809680001
1894
JARWIS
ISTRI
08/09/1968
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,206 0001604278912 1901041008950004
1894
ZAINUDIN
ANAK
10/08/1993
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,207 0001604278923 1971040111860005
1897
MARDAN
PESERTA
01/11/1986
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,208 0001604278934 1971045207900001
1897
FIKA PRIYANA
ISTRI
05/01/1989
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,209 0001604278945 1971045311880002
1897
HELEN LISA AYU PRAMISTI
ANAK
13/11/2008
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,210 0001604278956 1901040207800006
1900
AHMAD NABAWI
PESERTA
23/07/1980
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,211 0001604278967 1901044112870002
1900
MEGA WANA
ISTRI
12/05/1986
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,212 0001604278978 1901040307060001
1900
FAJAR SIDIK
ANAK
07/07/2007
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,213 0001604278989 1901042606900003
1903
BAMBANG
PESERTA
26/06/1990
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,214 0001604278991 1901045210920008
1903
SERI SURYANI
ISTRI
12/10/1992
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,215 0001604279002 1901042403110002
1903
MUHAMAD AKBAR
ANAK
24/03/2011
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,216 0001604279013 1901041512560001
1906
ABDUL GHONI
PESERTA
15/12/1956
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 314 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,217 0001604279024 1901044407590001
1906
ZUNAIDAH
ISTRI
04/07/1959
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,218 0001604279035 1901041303800002
1906
HARYUNI
ANAK
13/03/1980
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,219 0001604279046 1901041007880008
1906
AHMAD DAIROBI
ANAK
10/07/1987
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,220 0001604279057 1901042703920004
1906
RIPKI AHMAD
ANAK
27/03/1992
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,221 0001604279068 1901045308950003
1906
ROPIKOH
ANAK
15/08/1995
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,222 0001604279079 1901045008970006
1906
LATIPAH
ANAK
23/06/1996
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,223 0001604279081 1901044308830003
1913
SUSI SURYANI
PESERTA
03/05/1983
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,224 0001604279092 1901042010030003
1913
NURUL HIDAYAT
ANAK
20/10/2003
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,225 0001604279103 1901040107880101
1915
RIKI HARTONO
PESERTA
01/07/1988
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,226 0001604279114 1901044701900045
1915
ROSITA
ISTRI
07/01/1990
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,227 0001604279125 1901040211110004
1915
YUDIKA SAPUTRA
ANAK
02/11/2011
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,228 0001604279136 1901040404880003
1918
AMIR HAMZAH
PESERTA
04/04/1986
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,229 0001604279147 1901045510870001
1918
YUNA YUNARTI
ISTRI
15/10/1987
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,230 0001604279158 1901046901080001
1918
SAVINA TUNNAJA
ANAK
29/01/2008
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,231 0001604279169 1901043011110001
1918
VINO AL AZAM
ANAK
30/11/2011
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,232 0001604279171 1901040509620002
1922
HARTONO
PESERTA
05/09/1962
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,233 0001604279182 1901045206630002
1922
HOTIJAH
ISTRI
12/06/1963
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,234 0001604279193 1901044903920001
1922
HASANAH
ANAK
09/03/1992
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,235 0001604279204 1901041504930001
1922
JAUHARI
ANAK
15/04/1993
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,236 0001604279215 1901041007000003
1922
ARIYANTO
ANAK
10/07/2000
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,237 0001604279226 1901040507830007
1927
SAILAN
PESERTA
05/07/1983
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,238 0001604279237 1901044410860002
1927
NURAINA
ISTRI
04/10/1986
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,239 0001604279248 1901041311060003
1927
SOHIBUL AWLIYAK
ANAK
13/11/2006
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 315 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,240 0001604279259 1901040705100002
1927
TIJAN DARORI
ANAK
07/05/2010
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,241 0001604279261 1901041602810001
1931
JONI
PESERTA
16/02/1981
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,242 0001604279272 1901044510840003
1931
SUNARTI
ISTRI
05/10/1984
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,243 0001604279283 1901042912030001
1931
ANDRA PANGESTU
ANAK
29/12/2003
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,244 0001604279294 1901045005050004
1931
MAYANG SARI
ANAK
10/05/2005
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,245 0001604279305 1901041705090001
1931
MUHAMAD REFA
ANAK
17/05/2009
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,246 0001604279316 1901040510870006
1936
HERMANTO
PESERTA
05/10/1987
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,247 0001604279327 1901045003870005
1936
ZAIMAH
ISTRI
10/03/1987
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,248 0001604279338 1901040511060001
1936
FIRMANSYAH
ANAK
05/11/2006
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,249 0001604279349 1901040912840001
1939
SUDIRMAN
PESERTA
09/12/1984
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,250 0001604279351 1901045910870002
1939
FIFI SUMARNI
ISTRI
19/10/1987
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,251 0001604279362 1901045709060001
1939
TARI ANGULIA DETA
ANAK
17/09/2006
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,252 0001604279373 1901042802100001
1939
MAULIDRA
ANAK
28/02/2010
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,253 0001604279384 1901040808850001
1943
A.ZILI
PESERTA
08/08/1985
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,254 0001604279395 1901044603870002
1943
SAITI
ISTRI
06/03/1987
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,255 0001604279406 1901040812060005
1943
RIKI SAPUTRA
ANAK
17/08/2006
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,256 0001604279417 1901040612130001
1943
RAMADIAN
ANAK
06/12/2013
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,257 0001604279428 1901042205830001
1947
HENDI
PESERTA
22/05/1983
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,258 0001604279439 1901044908860002
1947
ASMARI
ISTRI
09/08/1986
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,259 0001604279441 1901042507030007
1947
ZHOHRI PRATAMA
ANAK
25/07/2003
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,260 0001604279452 1901042112090001
1947
ZHERLY ALZIKKRY
ANAK
21/12/2009
PENAGAN
01/02/2015
AKTIF
19,225
24/01/2015
7,261 0001604279463 1901041104760001
1953
BASIRIN
PESERTA
04/11/1976
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,262 0001604279474 1901044301760001
1953
NUR ZALASIAH
ISTRI
01/03/1976
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 316 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,263 0001604279485 1901044301980003
1953
NITA NURLINDA
ANAK
01/03/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,264 0001604279496 1901044208010003
1953
FITRI
ANAK
08/02/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,265 0001604279507 1901040607640001
1957
AMRIN
PESERTA
07/06/1964
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,266 0001604279518 1901045504690003
1957
YANTI
ISTRI
15/04/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,267 0001604279529 1901047101950001
1957
ARIANDANI
ANAK
31/01/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,268 0001604279531 1901045404000002
1957
ANJU
ANAK
14/04/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,269 0001604279542 1901044803600002
1962
SOL
PESERTA
03/08/1960
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,270 0001604279553 1901040102990004
1962
A'AN MUHAMAD NUR
ANAK
02/01/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,271 0001604279564 1301103112900001
1965
DEDI SAPUTRA
PESERTA
31/12/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,272 0001604279575 1901044912930002
1965
DESY TAMALA
ISTRI
12/09/1993
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,273 0001604279586 1901040701470005
1967
MAJAS
PESERTA
01/07/1947
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,274 0001604279597 1901044701500002
1967
SENAK
ISTRI
01/07/1950
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,275 0001604279608 1901041110880002
1973
ASMANU GUSTI YAWAN
PESERTA
10/11/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,276 0001604279619 1901045506080002
1973
ELLYN ANGGRAINI
ANAK
15/06/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,277 0001604279621 1901041912770001
1976
HERMANTO
PESERTA
19/12/1977
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,278 0001604279632 1901045912810001
1976
RINI
ISTRI
19/12/1981
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,279 0001604279643 1901040507030004
1976
MUHADAM
ANAK
07/05/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,280 0001604279654 1901041002090001
1976
RIKI FAREZA
ANAK
02/10/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,281 0001604279665 1901042008740002
1980
HASIRIN
PESERTA
20/08/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,282 0001604279676 1901045504840003
1980
SAKDA
ISTRI
15/04/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,283 0001604279687 1901046407090003
1980
NUR KHAISYA SALSA SABILA
ANAK
24/07/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,284 0001604279698 1901040504140001
1980
MUHAMMAD RIDHO FATULLAH ANAK
04/05/2014
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,285 0001604279709 1901040606600001
1984
ARDANI
06/06/1960
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
PESERTA
Page 317 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,286 0001604279711 1901044112650001
1984
SUHAIBI
ISTRI
12/01/1965
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,287 0001604279722 1901042301910002
1984
HERI KAPRI
ANAK
23/01/1991
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,288 0001604279733 1901041905050003
1984
TOMMY
ANAK
19/05/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,289 0001604279744 1901040306620003
1988
TAMAT
PESERTA
06/03/1962
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,290 0001604279755 1901046311650001
1988
SENUT
ISTRI
23/11/1965
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,291 0001604279766 1901042006950003
1988
SUKANDI
ANAK
20/06/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,292 0001604279777 1901045012980003
1988
TIA
ANAK
12/10/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,293 0001604279788 1901042311030004
1988
JUMARI
ANAK
23/11/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,294 0001604279799 1901040208060001
1988
JONI
ANAK
08/02/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,295 0001604279801 1901041004830001
1994
SAKBAN
PESERTA
04/10/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,296 0001604279812 1901044606850001
1994
ALYA
ISTRI
06/06/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,297 0001604279823 1901042203070002
1994
M. EKA MAULANA SAPUTRA
ANAK
20/03/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,298 0001604279834 1901047112430002
1994
ASNI
TAMBAHAN
31/12/1943
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,299 0001604279845 1901042404840004
1998
FAHRUZI
PESERTA
24/04/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,300 0001604279856 1901044707850002
1998
KARMILA
ISTRI
07/07/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,301 0001604279867 1901040107820133
2000
BAHARA
PESERTA
07/01/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,302 0001604279878 1901046308050005
2000
DIAH GUSTINI
ANAK
23/08/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,303 0001604279889 1901045901120001
2000
JUNITA BAHIRA
ANAK
19/01/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,304 0001604321864 1901040507890008
2006
JUPRI
PESERTA
07/05/1989
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,305 0001604321875 1901048001900002
2006
ASTERI
ISTRI
20/10/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,306 0001604321886 1901044410110002
2006
JUWANITA AULIA
ANAK
10/04/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,307 0001604321897 1901041011840002
2009
JUMLI
PESERTA
11/10/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,308 0001604321908 1901044307850004
2009
SUHAINI
ISTRI
07/03/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 318 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,309 0001604321919 1901044402050002
2009
GADIS
ANAK
02/04/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,310 0001604321921 1901042008060002
2009
GALANG
ANAK
20/08/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,311 0001604321932 1901041010710008
2013
SUHARDI
PESERTA
10/10/1971
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,312 0001604321943 1901044107750097
2013
ROMLAH
ISTRI
07/01/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,313 0001604321954 1901040506950003
2013
ROBIN
ANAK
06/05/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,314 0001604321965 1901044207970003
2013
ANI
ANAK
07/02/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,315 0001604321976 1901044404030006
2013
PIA
ANAK
04/04/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,316 0001604321987 1901044405100001
2013
INTAN UTAFIA
ANAK
05/04/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,317 0001604321998 1971011611860004
2019
SYAMSUL
PESERTA
16/11/1986
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,318 0001604322009 1971016010850006
2019
YULIA
ISTRI
20/10/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,319 0001604322011 1971015412040002
2019
DEDES ULANSARI
ANAK
14/12/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,320 0001604322022 1971016606060006
2019
DECA ULANDARI
ANAK
26/06/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,321 0001604322033 1901041510730003
2023
EDY SALHADI
PESERTA
15/10/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,322 0001604322044 1901045005790001
2023
YUNIAR
ISTRI
16/05/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,323 0001604322055 1901040511010003
2023
ANDRI YUDIANSYAH
ANAK
11/05/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,324 0001604322066 1901042007070004
2023
DAVA ANDIKA
ANAK
20/07/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,325 0001604322077 1901041606670001
2027
SUMARTO
PESERTA
16/06/1967
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,326 0001604322088 1901047112740007
2027
SUMARYUN
ISTRI
31/12/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,327 0001604322099 1901044212980001
2027
YEYEN FADILLA
ANAK
12/02/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,328 0001604322101 1901045409000004
2027
WITA SAWELA
ANAK
14/09/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,329 0001604322112 1901040602050005
2027
ILHAM
ANAK
02/06/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,330 0001604322123 1901041004740002
2032
ISWADI
PESERTA
04/10/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,331 0001604322134 1901046901750001
2032
SINAR
ISTRI
29/01/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 319 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,332 0001604322145 1901041708000003
2032
RENDI
ANAK
17/08/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,333 0001604322156 1901042310030002
2032
REFALDI
ANAK
23/10/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,334 0001604322167 1901046311070003
2032
WINDI
ANAK
23/11/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,335 0001604322178 1901042401740001
2037
KASRUDIN
PESERTA
24/01/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,336 0001604322189 1901045712790001
2037
SAIRAH
ISTRI
17/12/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,337 0001604322191 1901042209020001
2037
FARIZAN ALANZORI
ANAK
22/09/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,338 0001604322202 1971016109800001
2040
DEWI YANTRI
PESERTA
21/09/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,339 0001604322213 1971010908000005
2040
AGUSTIAN INDAH PRATAMA
ANAK
08/09/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,340 0001604322224 1901010410070006
2040
HAIDILLAH
ANAK
10/04/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,341 0001604322235 1901041605570001
2043
ZAINAL
PESERTA
16/05/1957
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,342 0001604322246 1901045010600001
2043
ROMIDAH
ISTRI
10/10/1960
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,343 0001604322257 1901046011870001
2043
JUMYANI
ANAK
20/11/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,344 0001604322268 1901042909910001
2043
SYAIFUL
ANAK
29/09/1991
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,345 0001604322279 1901046804980003
2043
EVI
ANAK
18/04/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,346 0001604322281 1901042303730004
2048
ARIANDI
PESERTA
23/03/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,347 0001604322292 1901044508750001
2048
SUMARTINI
ISTRI
08/05/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,348 0001604322303 1901045109960001
2048
LISNAWATI
ANAK
09/11/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,349 0001604322314 1901041907970002
2048
MUHAMMAD YULI ISNAINI
ANAK
19/07/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,350 0001604322325 1901044610050003
2048
NIA DESTI
ANAK
10/06/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,351 0001604322336 1901044610070002
2048
LINA RAMADANI
ANAK
10/06/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,352 0001604322347 1901043112700004
2054
UMARDANI
PESERTA
31/12/1970
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,353 0001604322358 1901047112790004
2054
HERNANI
ISTRI
31/12/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,354 0001604322369 1901041404980004
2054
ARDINO
ANAK
14/04/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 320 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,355 0001604322371 1901047006000003
2054
YULIA
ANAK
30/06/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,356 0001604322382 1901041710090001
2054
ALFIAN
ANAK
17/10/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,357 0001604322393 1901041402700004
2059
JUMLI
PESERTA
14/02/1970
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,358 0001604322404 1901045503750002
2059
AINA
ISTRI
15/03/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,359 0001604322415 1901042303960008
2059
ARI MANDALA PUTRA
ANAK
23/03/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,360 0001604322426 1901042908020002
2059
AHMAD MULYADI
ANAK
29/08/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,361 0001604322437 1901041912060004
2059
DODY IRWANSYAH PUTRA
ANAK
19/12/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,362 0001604322448 1901042301860002
2068
SYAMSUDIN
PESERTA
23/01/1986
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,363 0001604322459 1901041507510003
2069
USMAN
PESERTA
15/07/1951
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,364 0001604322461 1901044509560001
2069
NASIAH
ISTRI
09/05/1956
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,365 0001604322472 1901040107460024
2076
ALI
PESERTA
07/01/1946
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,366 0001604322483 1901044107510040
2076
ROSNAH
ISTRI
07/01/1951
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,367 0001604322494 1901041410860002
2076
BUDIMAN
ANAK
14/10/1986
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,368 0001604322505 1901040505790003
2079
PAHAR
PESERTA
05/05/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,369 0001604322516 1901045007790004
2079
MAIMUNAH
ISTRI
07/10/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,370 0001604322527 1901042009980002
2079
FRENGKY TORNADO
ANAK
20/09/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,371 0001604322538 1901042808030004
2079
RANGGA DEWANDA
ANAK
28/08/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,372 0001604322549 1901044712090002
2079
BUNGA LESTARI
ANAK
12/07/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,373 0001604322551 1901042208140002
2079
ANGGA SAPUTRA
ANAK
22/08/2014
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,374 0001604322562 1901040250810003
2085
SAMUDERA
PESERTA
03/03/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,375 0001604322573 1901045010850003
2085
NENENG
ISTRI
10/10/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,376 0001604322584 1901042901790001
2087
MUHAMMAD FAJRI
PESERTA
29/01/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,377 0001604322595 1901046407820001
2087
YULIA
ISTRI
24/07/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 321 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,378 0001604322606 1901045405070001
2087
AURELLIA FAJRIANTI
ANAK
14/05/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,379 0001604322617 1901045601100001
2087
NUR AQIELA FAJRIANTI
ANAK
18/01/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,380 0001604322628 1901041205130002
2087
RIZQI SALMAN AL FAJRI
ANAK
05/12/2013
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,381 0001604322639 1901041803610001
2092
SUIB
PESERTA
18/03/1961
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,382 0001604322641 1901046104590001
2092
FATIMAH
ISTRI
21/04/1959
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,383 0001604322652 1901040806950002
2092
RESKI FAJRI
ANAK
06/08/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,384 0001604322663 1901041509970004
2092
MUJI SLAMET
ANAK
15/09/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,385 0001604322674 1901040309680001
2096
MUHAMAD SATAR
PESERTA
09/03/1968
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,386 0001604322685 1901044310000002
2096
SANTIKARATI
ANAK
10/03/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,387 0001604322696 1901044911050002
2096
RISKA NOVITASARI
ANAK
11/09/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,388 0001604322707 1901044602060002
2100
ALYA
PESERTA
02/06/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,389 0001604322718 1901045312120002
2100
ANISA
ANAK
13/12/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,390 0001604322729 1901040610660003
2103
BUDIYONO
PESERTA
10/06/1966
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,391 0001604322731 1901046005790002
2103
SAIBA
ISTRI
20/05/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,392 0001604322742 1901047105920001
2103
SITI AMINAH
ANAK
31/05/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,393 0001604322753 1901045012990003
2103
ANNA SIAH NUR AISAH
ANAK
12/10/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,394 0001604322764 1901046203070001
2103
SITI AMINATUZ ZAHRIYAH
ANAK
22/03/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,395 0001604322775 1901044609080001
2103
KHOLIFATUL KHASANAH
ANAK
06/09/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,396 0001604322786 1901041201820003
2103
CHOIRUL ANAM
ANAK
01/12/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,397 0001604322797 1901040107750067
2111
RAHMAN
PESERTA
07/01/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,398 0001604322808 1901047112770004
2111
JAMILAH
ISTRI
31/12/1977
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,399 0001604322819 1901043005120002
2111
MUHAMAD FAOUZAN
ANAK
30/05/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,400 0001604322821 1901041612970001
2111
JOHAN
ANAK
16/12/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 322 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,401 0001604322832 1901042211010002
2111
DIMAS
ANAK
22/11/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,402 0001604322843 1901040108420002
2122
SIAN H.
PESERTA
08/01/1942
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,403 0001604322854 1901043112680003
2133
SARMIDI
PESERTA
31/12/1968
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,404 0001604322865 1901047112740005
2133
HERMIYATI
ISTRI
31/12/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,405 0001604322876 1901047105010003
2133
SUKMA PRANSISKA
ANAK
31/05/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,406 0001604322887 1901045305070003
2133
VIKA RAHERLIA
ANAK
13/05/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,407 0001604322898 1901040102370001
2139
ISMAIL H.
PESERTA
02/01/1937
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,408 0001604322909 1901044102410001
2139
RUSNAH Hj.
ISTRI
02/01/1942
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,409 0001604322911 1901042901800002
2141
ADI
PESERTA
29/01/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,410 0001604322922 1901045407830002
2141
SARIPAH
ISTRI
14/07/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,411 0001604322933 1901042708030004
2141
RICO CANDRA
ANAK
27/08/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,412 0001604322944 1901042009870001
2144
ABDUL JHONI
PESERTA
20/09/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,413 0001604322955 1901045209890003
2144
KASMIYANA
ISTRI
09/12/1989
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,414 0001604322966 1901045611090002
2144
AYRIN ANGGRAINI
ANAK
16/11/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,415 0001604322977 1901040605740003
2147
ALIM
PESERTA
05/06/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,416 0001604322988 1901045407760002
2147
TRI WAHYUNI
ISTRI
14/07/1976
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,417 0001604322999 1901046508970002
2147
ALPIYANI
ANAK
25/08/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,418 0001604323001 1901045611060003
2147
NOVITRI BULANDARI
ANAK
26/11/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,419 0001604323012 1901040808520001
2152
ABIDIN
PESERTA
08/08/1952
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,420 0001604323023 1901046109690001
2152
PATIMAH
ISTRI
21/09/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,421 0001604323034 1901046609910002
2152
SUSILAWATI WULANDARI
ANAK
26/09/1991
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,422 0001604323045 1901041303960001
2152
ABDURRAHMAN
ANAK
03/03/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,423 0001604323056 1901042912020003
2152
MUHAMMAD NURHASAN
ANAK
29/12/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 323 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,424 0001604323067 1901041801750002
2157
RIDUAN
PESERTA
18/01/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,425 0001604323078 1901047012870001
2157
WATI
ISTRI
30/12/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,426 0001604323089 1901044307090001
2157
MITAHUL JANNAH
ANAK
07/03/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,427 0001604323091 1901046910040003
2157
FANIA ENDARYANI
ANAK
10/09/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,428 0001604323102 1901040201580001
2162
ANWAR
PESERTA
01/02/1958
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,429 0001604323113 1901044505640004
2162
ALMA
ISTRI
05/05/1964
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,430 0001604323124 1901045707840005
2162
ANI
ANAK
17/07/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,431 0001604323135 1901045901920002
2162
NINI
ANAK
19/01/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,432 0001604323146 1901042312820001
2166
LAHMUDIN
PESERTA
23/12/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,433 0001604323157 1901045412870002
2166
IRAWATI
ISTRI
14/12/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,434 0001604323168 1901041401060001
2166
IRGAN ALZAKI
ANAK
14/01/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,435 0001604323179 1901042502090001
2166
ADRIAN
ANAK
25/02/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,436 0001604323181 1901042701700001
2170
RIDWAN
PESERTA
27/01/1970
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,437 0001604323192 1901044810820004
2170
MAINI
ISTRI
10/08/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,438 0001604323203 1901045801080001
2170
RISKA
ANAK
18/01/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,439 0001604323214 1901045201910001
2173
JUNIATI
PESERTA
01/12/1991
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,440 0001604323225 1901045902130002
2173
NADIA
ANAK
19/02/2013
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,441 0001604323236 1901040606790005
2175
AMRI
PESERTA
06/08/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,442 0001604323247 1901046810830002
2175
SULISTRI NINGSIH
ISTRI
28/10/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,443 0001604323258 1901046311120001
2175
MOZA ALZILA ZAMRY
ANAK
23/11/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,444 0001604323269 1901040107580060
2178
USMAN
PESERTA
07/01/1958
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,445 0001604323271 1901040468890002
2178
SAIMI
ANAK
06/04/1989
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,446 0001604323282 1901042606600001
2181
SOLIHUN
PESERTA
28/06/1960
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 324 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,447 0001604323293 1901046505600001
2181
SUMIRA
ISTRI
25/05/1960
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,448 0001604323304 1901044806920001
2181
NURLAILA
ANAK
06/08/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,449 0001604323315 1901040702870004
2185
ZULKIPLI
PESERTA
02/07/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,450 0001604323326 1901045203830002
2185
YUYUN
ISTRI
03/12/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,451 0001604323337 1901042010120001
2185
ALDIN FAUZAN
ANAK
20/10/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,452 0001604323348 1901040107430025
2188
JUHAR
PESERTA
07/04/1943
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,453 0001604323359 1901044107450041
2188
SEMAH
ISTRI
07/01/1945
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,454 0001604323361 1901040406610002
2190
SAKNOH
PESERTA
08/04/1961
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,455 0001604323372 1901044502620003
2190
SUBAIDAH
ISTRI
02/05/1962
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,456 0001604323383 1901044201900001
2190
SURYATI
ANAK
01/02/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,457 0001604323394 1901044604990002
2190
NARTIK
ANAK
04/06/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,458 0001604323405 1901044409040003
2190
PITRI
ANAK
08/04/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,459 0001604323416 1901041205820003
2196
SUKIRMAN
PESERTA
05/12/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,460 0001604323427 1901045007800004
2196
ALIA
ISTRI
07/10/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,461 0001604323438 1901044404020002
2196
AMBAR NURYANA
ANAK
04/04/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,462 0001604323449 1901041510650001
2200
USMAN
PESERTA
15/10/1965
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,463 0001604323451 1901045807600001
2200
SOT
ISTRI
18/07/1960
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,464 0001604323462 1901042804890001
2200
LEO ARI SAPUTRA
ANAK
28/04/1989
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,465 0001604323473 1901047112720005
2207
TATI
PESERTA
31/12/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,466 0001604323484 1901040508930002
2207
WIDI ARDIYANSYAH
ANAK
08/05/1993
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,467 0001604323495 1901040411950005
2207
FEBRIYANTO
ANAK
11/04/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,468 0001604323506 1901041304000003
2207
ANDA CHRISTIAWAN
ANAK
13/04/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,469 0001604323517 1901041609510001
2211
ABDURRAHMAN
PESERTA
16/09/1951
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 325 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,470 0001604323528 1901042209010004
2211
BUDIMAN
ANAK
22/09/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,471 0001604323539 1901041210150001
2213
AMMRI
PESERTA
10/12/1965
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,472 0001604323541 1901042102980085
2213
MUH.KARIM ALJABAR
ALJAHBARI
ANAK
21/02/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,473 0001604323552 1901040906490003
2213
MUH.IMAM ALAKBAR
ALBARESI
ANAK
21/06/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,474 0001604323563 1901041105040005
2213
MUH. BAIH BADER AL BADAWI ANAK
05/11/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,475 0001604323574 1901044311060001
2213
MARYATUL KIFYAH
ANAK
23/11/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,476 0001604323585 1901041010740001
2218
SUMARLIN
PESERTA
10/10/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,477 0001604323596 1901045209800001
2218
SARTINI
ISTRI
09/12/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,478 0001604323607 1901046808990003
2218
AGUSTINA NURMASAN
ANAK
28/08/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,479 0001604323618 1901042005070001
2218
M.FAJRI ALI AKBAR
ANAK
20/05/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,480 0001604323629 1901046602090001
2218
NURLITA AZIZAH
ANAK
26/02/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,481 0001604323631 1901040110610001
2224
ROSMIDI
PESERTA
01/01/1961
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,482 0001604323642 1901044107650116
2224
ASMAH
ISTRI
07/01/1965
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,483 0001604323653 1901046204940004
2224
DESI
ANAK
22/04/1994
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,484 0001604323664 1901046105960002
2224
DEWI
ANAK
21/05/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,485 0001604323675 1901041202030002
2224
DELI
ANAK
02/12/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,486 0001604323686 1901040101040018
2224
DEKI
ANAK
01/01/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,487 0001604323697 1901042006810001
2235
BADRIN
PESERTA
20/06/1981
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,488 0001604323708 1901046006810001
2235
SAFARIDA
ISTRI
20/06/1981
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,489 0001604323719 1901041407010001
2235
YULIAN SAPUTRA
ANAK
14/07/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,490 0001604323721 1901045404060001
2235
EGA ARIANTI
ANAK
14/04/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,491 0001604323732 1901042108900004
2239
AGUS SUPRIYANTO
PESERTA
08/07/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 326 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,492 0001604323743 1901044510930001
2239
OKVITA FITRI DIYANTARI
ISTRI
10/05/1993
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,493 0001604323754 1901040504630003
2241
LEONARDO
PESERTA
04/05/1963
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,494 0001604323765 1901040809060002
2241
PUTRA SEPTIAN RHUANDA

LEONARDO
ANAK
09/08/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,495 0001604323776 1901041507690009
2244
SAIMAN SUQIMAN
PESERTA
15/07/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,496 0001604323787 1901040105770003
2245
SAIKONI
PESERTA
05/01/1977
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,497 0001604323798 1901044028300001
2245
AROAINI
ISTRI
02/04/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,498 0001604323809 1901042001980001
2245
DARHADI
ANAK
20/01/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,499 0001604323811 1901042704010002
2245
SURYADI
ANAK
27/04/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,500 0001604323822 1901047005030001
2245
SARI
ANAK
30/05/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,501 0001604323833 1901042412050001
2245
YOGA
ANAK
24/12/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,502 0001604323844 1901040101740006
2251
SAYUDIN
PESERTA
01/01/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,503 0001604323855 1901044504760006
2251
SURYATI
ISTRI
04/05/1976
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,504 0001604323866 1901042710990001
2251
FIRMANSYAH
ANAK
27/10/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,505 0001604323877 1901040607020004
2251
PARMIN
ANAK
02/06/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,506 0001604323888 1901044506050002
2251
YENI
ANAK
06/05/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,507 0001604323899 1901045748120002
2251
SIPA
ANAK
17/08/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,508 0001604323901 1901042022570001
2257
ISHAK
PESERTA
02/12/1957
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,509 0001604323912 1901041076600074
2257
ALWIA
ISTRI
07/01/1956
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,510 0001604323923 1901040107570099
2261
GUNDUL
PESERTA
07/01/1957
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,511 0001604323934 1901044903620003
2261
AIDAH
ISTRI
03/09/1962
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,512 0001604323945 1901040306910002
2261
GEPENG
ANAK
06/03/1991
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,513 0001604323956 1901045507960001
2261
YULITA
ANAK
15/07/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,514 0001604323967 1901040107700082
2269
SALIM WAHYUDI
PESERTA
07/01/1970
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 327 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,515 0001604323978 1901044107670143
2269
SURYANI
ISTRI
07/01/1967
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,516 0001604323989 1901040206770001
2271
SUHALMI
PESERTA
06/02/1977
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,517 0001604323991 1901044208770003
2271
HALIAH
ISTRI
08/02/1977
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,518 0001604324002 1901044801030005
2271
RISTIKA AYU
ANAK
01/08/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,519 0001604324013 1901041705870003
2275
SUHARDI
PESERTA
17/05/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,520 0001604324024 1901045010900001
2275
KARMILA
ISTRI
10/10/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,521 0001604324035 1901044508070003
2275
NADIA EKA YUNIA
ANAK
08/05/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,522 0001604324046 1901045404740003
2281
HAMIDAH
PESERTA
14/04/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,523 0001604324057 1901042005920005
2281
HENDRA HAYADI
ANAK
20/05/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,524 0001604324068 1901041205970003
2281
EGO SAPUTRA
ANAK
05/12/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,525 0001604324079 1901042612020002
2281
RIFKI SAWAL ALAMSAH
ANAK
26/12/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,526 0001604324081 1901045510060005
2281
SUCI FATMAWATI
ANAK
15/10/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,527 0001604324092 1901040412090001
2281
FEBRIAN SEPTA WIJAYA
ANAK
12/04/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,528 0001604324103 1901041201620001
2287
MISDARWINTO
PESERTA
01/12/1962
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,529 0001604324114 1901045803720001
2287
SUPRIYATIN
ISTRI
18/03/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,530 0001604324125 1901042201000004
2287
DEDI RACHMAT HARDIANTO
ANAK
22/01/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,531 0001604324136 1901041306550001
2290
MUHAMMAD
PESERTA
13/06/1955
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,532 0001604324147 1901045501600002
2290
HOLIPAH
ISTRI
15/01/1960
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,533 0001604324158 1901040107920093
2290
RIZAL
ANAK
21/02/1993
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,534 0001604324169 1901041310990002
2290
RIFKI BOY
ANAK
13/10/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,535 0001604324171 1901045006010006
2290
NIA RAMADHANI
ANAK
12/09/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,536 0001604324182 1901040205630003
2296
SYAMSUDIN
PESERTA
05/02/1963
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,537 0001604324193 1901044709660002
2296
NOR
ISTRI
09/07/1966
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 328 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,538 0001604324204 1901041802900003
2296
ISKANDAR
ANAK
18/02/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,539 0001604324215 1302130610870003
2299
YOS AFRIZAL
PESERTA
10/06/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,540 0001604324226 1901046411920006
2299
SULASTRI
ISTRI
24/11/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,541 0001604324237 1901046410110001
2299
FIONA FAKRUB NIZAQ
ANAK
24/10/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,542 0001604324248 1901040606540002
2302
ACHAMD SALIM
PESERTA
06/06/1954
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,543 0001604324259 1901047112650005
2302
MAIMUNAH
ISTRI
31/12/1965
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,544 0001604324261 1901043112620010
2304
AMAT
PESERTA
31/12/1962
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,545 0001604324272 1901046507630000
2304
SUMARNI
ISTRI
15/07/1963
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,546 0001604324283 1901045403870001
2304
JURIAH
ANAK
24/03/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,547 0001604324294 1901042110940000
2304
MIDUN
ANAK
21/10/1991
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,548 0001604324305 1901045007800003
2308
HOLLY
PESERTA
07/10/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,549 0001604324316 1901042701070002
2308
M. HABIB PUTRA
ANAK
27/01/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,550 0001604324327 1901041108690001
2310
SUWANDI
PESERTA
08/11/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,551 0001604324338 1901042312120001
2310
ADE HAIKAL KURNIAWAN
ANAK
23/12/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,552 0001604324349 1901042410710002
2315
BUJANG TINGGAL
PESERTA
24/10/1971
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,553 0001604324351 1901046810770002
2315
HAMSIAH
ISTRI
28/10/1977
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,554 0001604324362 1901044707960003
2315
YULITA
ANAK
07/07/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,555 0001604324373 1901046103990001
2315
MIRDA
ANAK
21/03/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,556 0001604324384 1901045506070007
2315
MIRNA ALFINA SARI
ANAK
15/06/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,557 0001604324395 1901040107490032
2321
APUK
PESERTA
07/01/1949
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,558 0001604324406 1901044107570100
2321
SAUNAH
ISTRI
07/01/1957
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,559 0001604324417 1901041910800003
2321
BAHRUN
ANAK
19/10/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,560 0001604324428 1901041010870005
2321
SUPRI
ANAK
10/10/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 329 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,561 0001604324439 1901041211520001
2332
ROJA'I
PESERTA
11/12/1952
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,562 0001604324441 1901042609860001
2333
EDDI
PESERTA
26/09/1986
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,563 0001604324452 1901044205870004
2333
ROMIYATRI
ISTRI
05/02/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,564 0001604324463 1901044512080001
2333
EPETLI
ANAK
12/05/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,565 0001604324474 1901040507480003
2345
JAKFAR
PESERTA
07/05/1948
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,566 0001604324485 1901045507500001
2345
MOK
ISTRI
15/07/1950
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,567 0001604324496 1901044608620001
2355
TINI
PESERTA
08/08/1962
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,568 0001604324507 1901041604910002
2355
SAMSUDIN
ANAK
16/04/1991
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,569 0001604324518 1901040402820001
2360
SUPARDI
PESERTA
04/02/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,570 0001604324529 1901046108890001
2360
HERVIKA
ISTRI
21/08/1989
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,571 0001604324531 1901046408070001
2360
CICI VELIKA
ANAK
24/08/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,572 0001604324542 1904050601790001
2366
ANDRIYANTO
PESERTA
01/06/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,573 0001604324553 1901046010840003
2366
MAIMUNAH
ISTRI
20/10/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,574 0001604324564 1901040705090001
2366
PUTRA WIJAYA HARTADINATA ANAK
05/07/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,575 0001604324575 1971040609660003
2369
GUSTAMI
PESERTA
09/06/1966
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,576 0001604324586 1971045502770002
2369
HERNI
ISTRI
15/02/1977
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,577 0001604324597 1971040511990003
2369
PANGERAN MUHAMMAD
ANAK
11/05/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,578 0001604324608 1971044707020002
2369
YULIANA
ANAK
07/07/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,579 0001604324619 1971045510040004
2369
PUSPA WULANSARI
ANAK
15/10/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,580 0001604324621 1971045503080001
2369
MARSELLINA
ANAK
15/03/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,581 0001604324632 1901041909750001
2375
HAIRONI
PESERTA
19/09/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,582 0001604324643 1901044303840004
2375
ICA
ISTRI
03/03/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,583 0001604324654 1901044110040007
2375
MUSTARI
ANAK
10/01/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 330 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,584 0001604324665 1901042201110001
2375
CHIFA MUSTAFA
ANAK
22/01/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,585 0001604324676 1901041109860001
2379
HARMODIN
PESERTA
09/11/1986
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,586 0001604324687 1901047103870001
2379
MARTINA
ISTRI
31/03/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,587 0001604324698 1901046005020001
2379
MAISA ALISIA
ANAK
20/05/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,588 0001604324709 1901044103120001
2379
NABILA
ANAK
03/01/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,589 0001604324711 1901040107780001
2383
SARMAWI
PESERTA
07/01/1978
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,590 0001604324722 1901046612830002
2383
WIWIK
ISTRI
26/12/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,591 0001604324733 1901046001010001
2383
MELISA
ANAK
20/01/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,592 0001604324744 1901046506030001
2383
SAFITRI
ANAK
25/06/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,593 0001604324755 1901040403480002
2387
ASNAWI
PESERTA
03/04/1948
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,594 0001604324766 1901046106540001
2387
SOLBIAH
ISTRI
21/06/1954
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,595 0001604324777 1901041703870002
2387
ASRIN
ANAK
17/03/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,596 0001604324788 1901044212890001
2387
ANIKA
ANAK
12/02/1989
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,597 0001604324799 1901042403890004
2392
YUMARDIANSYAH
PESERTA
24/03/1989
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,598 0001604324801 1901044911960003
2392
ASIH PURWASIH
ANAK
11/09/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,599 0001604324812 1901044510070003
2392
MUTIA RAMADANI
ANAK
01/05/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,600 0001604324823 1901041708840007
2395
SUPRI
PESERTA
17/08/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,601 0001604324834 1901045207800001
2395
SITI KOMARIAH
ISTRI
07/12/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,602 0001604324845 1901045311070001
2395
LESTIA FATMAWATI
ANAK
13/11/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,603 0001604324856 1901046206100002
2395
FITRI AULIA
ANAK
22/06/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,604 0001604324867 1901041208880002
2399
ARIJAL
PESERTA
08/12/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,605 0001604324878 1901046011880001
2399
AISYAH
ISTRI
20/11/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,606 0001604324889 1901046609090003
2399
RINI RAHMI ELVINA
ANAK
26/09/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 331 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,607 0001604324891 1901041111870004
2399
JHONY IRAWAN
ANAK
11/11/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,608 0001604324902 1901041705520001
2407
AMIN AMBUL
PESERTA
17/05/1952
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,609 0001604324913 1901046803550001
2407
ASMAH
ISTRI
26/03/1955
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,610 0001604324924 1901040107550009
2409
SAMSUL
PESERTA
07/01/1955
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,611 0001604324935 1901044107750120
2409
AINI
ISTRI
07/01/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,612 0001604324946 1901046703990003
2409
MEGA
ANAK
27/03/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,613 0001604324957 1901046604000003
2409
SITA
ANAK
28/04/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,614 0001604324968 1901041202050001
2409
MUHAMAD ILHAM
ANAK
02/12/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,615 0001604324979 1901041807760001
2416
M.YUNUS
PESERTA
18/07/1976
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,616 0001604324981 1901047107810001
2416
ROPIAH
ISTRI
31/07/1981
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,617 0001604324992 1901042207010002
2416
M. JULIANTO
ANAK
22/07/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,618 0001604325003 1901044910070002
2416
RAMANIA
ANAK
10/09/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,619 0001604325014 1901041004840001
2420
SASTRIYANTO
PESERTA
04/10/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,620 0001604325025 1901045208840001
2420
MARHAYATIN
ISTRI
08/12/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,621 0001604325036 1901042210060002
2420
MUHAMMAD ARIL PRATAMA
ANAK
22/10/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,622 0001604325047 1901044101700007
2431
MISNAH
PESERTA
01/01/1970
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,623 0001604325058 1901040701900005
2433
RAHMAT
PESERTA
01/07/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,624 0001604325069 1901044803940001
2433
NURJANAH
ISTRI
03/08/1994
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,625 0001604325071 1901044408110001
2433
RAHMITA NURMALA
ANAK
08/04/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,626 0001604325082 1901041306740003
2436
SOLEH
PESERTA
13/06/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,627 0001604325093 1901044106740006
2436
MONG
ISTRI
06/01/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,628 0001604325104 1901045405940001
2436
HENDRI
ANAK
14/05/1994
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,629 0001604325115 1901045208980003
2436
LENI
ANAK
08/12/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 332 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,630 0001604325126 1901040102010004
2436
HENDRA MARYOYO
ANAK
02/01/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,631 0001604325137 1901043112790003
2441
SUPARDI
PESERTA
31/12/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,632 0001604325148 1901045012750001
2441
CIKNA
ISTRI
12/10/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,633 0001604325159 1901041901030001
2441
IMAN ANTORI
ANAK
19/02/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,634 0001604325161 1901046502120001
2441
SALSABILA AZZAHRA
ANAK
25/02/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,635 0001604325172 1608060406770002
2448
SYAIFUL ANWAR
PESERTA
06/04/1977
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,636 0001604325183 1901040704140002
2448
EZRA ABARRA
ANAK
04/07/2014
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,637 0001604325194 1608041305070001
2448
AHMADI YANSYAH
ANAK
13/05/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,638 0001604325205 1901040106690001
2452
MUSTOPA KAMAL
PESERTA
06/01/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,639 0001604325216 1901047012750003
2452
ZAINUBAH
ISTRI
30/12/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,640 0001604325227 1901042708940002
2452
DENNY CANDRA
ANAK
27/08/1994
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,641 0001604325238 1901046504980005
2452
PATIMA
ANAK
25/04/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,642 0001604325249 1901045902050002
2452
NANDA AMELIA
ANAK
19/02/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,643 0001604325251 1901042503920002
2457
ZUKRIADI
PESERTA
25/03/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,644 0001604325262 1901044610910002
2457
YANA
ISTRI
10/06/1991
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,645 0001604325273 1901044107130002
2457
ALFI MUKMINAH
ANAK
07/01/2013
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,646 0001604325284 1901044906670001
2460
ROKOYAH
PESERTA
06/09/1967
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,647 0001604325295 1901042909960001
2460
M. FIRNANDO
ANAK
29/09/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,648 0001604325306 1901041708040005
2460
BAGUS SAPUTRA
ANAK
17/08/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,649 0001604325317 1901041302880002
2465
JUNAIDI
PESERTA
13/02/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,650 0001604325328 1901048512810003
2465
LINDA LAYUNG AGUNG
ISTRI
25/12/1981
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,651 0001604325339 1901041301870001
2467
BASIRIN
PESERTA
13/01/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,652 0001604325341 1901047112780001
2467
SAUYUN
ISTRI
31/12/1978
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 333 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,653 0001604325352 1901042906100002
2467
JHONATAN FRISKY
ANAK
29/06/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,654 0001604325363 1901040304830006
2470
ASMAN
PESERTA
04/03/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,655 0001604325374 1901045809840001
2470
SAUNI
ISTRI
18/09/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,656 0001604325385 1901044302030004
2470
MEGA PURWALA
ANAK
02/03/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,657 0001604325396 1901042901090002
2470
ADHLI AFRIANDI
ANAK
29/01/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,658 0001604325407 1901043112800001
2474
ANDAYUDI
PESERTA
31/12/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,659 0001604325418 1901045206870002
2474
FIKADURI
ISTRI
06/12/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,660 0001604325429 1901040312080003
2474
DENI ANDAYUDI
ANAK
12/03/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,661 0001604325431 1901042106660006
2477
SUPARDI
PESERTA
21/06/1966
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,662 0001604325442 1901046508670003
2477
ROMINUN
ISTRI
25/08/1967
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,663 0001604325453 1901042204030005
2477
REZA
ANAK
22/04/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,664 0001604325497 1901040605830001
2483
ANZILI
PESERTA
08/05/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,665 0001604325508 1901045001900001
2483
ROBITOH
ISTRI
10/01/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,666 0001604325519 1901040508100006
2483
ABDUSSALAM
ANAK
05/08/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,667 0001604325521 1901045905130001
2483
WAALIDATUL MURSYIDA
ANAK
19/05/2013
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,668 0001604325532 1901042310840002
2487
HERI KUSUMA
PESERTA
23/10/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,669 0001604325543 1901046406890002
2487
MASTURI
ISTRI
24/06/1989
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,670 0001604325554 1901041002110001
2487
NURYL MAULIDI
ANAK
10/02/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,671 0001604325565 1901041508850002
2490
HUSNIL FIKRI
PESERTA
15/08/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,672 0001604325576 1901044704880002
2490
INDRAWATI
ISTRI
07/04/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,673 0001604325587 1901041801070005
2490
MUHAMMAD RIFKI
ANAK
18/01/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,674 0001604325598 1901046603880002
2494
MI'ROJAH
PESERTA
26/03/1986
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,675 0001604325609 1901043006080002
2494
ABDARUL RAFIKI
ANAK
30/06/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 334 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,676 0001604325611 1901042804120003
2494
ALDY ALDIAYANSYAH
ANAK
28/04/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,677 0001604325622 1901044107900133
2498
SRI AGUSTINA
PESERTA
01/07/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,678 0001604325633 1901040410080002
2498
ZAKI FIRMANSYAH
ANAK
04/10/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,679 0001604325644 1901040101560001
2500
JUMLI
PESERTA
01/01/1958
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,680 0001604325655 1901044107580036
2500
SOLIDA
ISTRI
01/07/1962
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,681 0001604325666 1901040207850004
2500
ARPANDI
ANAK
02/07/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,682 0001604325677 1901046205950001
2500
MELIYANA
ANAK
22/05/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,683 0001604325688 1901042405970002
2500
SUHENDRI
ANAK
24/05/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,684 0001604325699 1901040707750003
2505
SULAS
PESERTA
07/07/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,685 0001604325701 1901045012850001
2505
LIA ULFA
ISTRI
10/12/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,686 0001604325712 1901042012090002
2505
WILDAN SALIM
ANAK
20/12/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,687 0001604325723 1901040306800001
2509
JONI
PESERTA
03/06/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,688 0001604325734 1901045010750002
2509
ZAINUNAH
ISTRI
10/10/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,689 0001604325745 1901040409050003
2509
MUHAMMAD NUR
ANAK
04/09/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,690 0001604325756 1901044302070001
2509
SIFAUL ATZKIA'
ANAK
03/02/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,691 0001604325767 1901045311100001
2509
MAR'ATUS SAFA'AH
ANAK
13/11/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,692 0001604325778 1901041303630001
2514
ARWIN
PESERTA
13/03/1963
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,693 0001604325789 1901046209680002
2514
NORYANI
ISTRI
22/09/1963
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,694 0001604325791 1901044110920005
2514
ERNI YUSNITA
ANAK
01/10/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,695 0001604325802 1901046706970004
2514
ANA PUJI LESTARI
ANAK
27/06/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,696 0001604325813 1901041009770005
2518
AHMAD MUSAYIP
PESERTA
10/09/1977
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,697 0001604325824 1901044111840004
2518
HAMSIAH
ISTRI
01/11/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,698 0001604325835 1901045706050005
2518
ASSA'ADAH
ANAK
17/06/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 335 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,699 0001604325846 1901046904090001
2518
RAHMATUS SHOFAH
ANAK
29/04/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,700 0001604325857 1901045005120001
2518
ZAHRATUN NAJWA
ANAK
10/05/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,701 0001604325868 1901042407520001
2523
M.TARPIN
PESERTA
24/07/1952
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,702 0001604325879 1901044107670084
2523
ZUBAIDAH
ISTRI
01/07/1967
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,703 0001604325881 1901040107950055
2523
A.ROMADI
ANAK
01/07/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,704 0001604325892 1901040107040039
2523
ANDRIAN MAULANA
ANAK
01/07/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,705 0001604325903 1901042403560001
2527
ANSORI
PESERTA
23/04/1956
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,706 0001604325914 1901046103590001
2527
ROZAMI
ISTRI
21/03/1959
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,707 0001604325925 1901045709870003
2527
SUSANTI
ANAK
17/09/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,708 0001604325936 1901045304940001
2527
SRI HARTINA
ANAK
13/04/1994
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,709 0001604325947 1901040401020006
2527
RIZKI WAHYUDI
ANAK
04/01/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,710 0001604325958 1901044311080002
2527
DEVASILA
TAMBAHAN
03/11/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,711 0001604325969 1901041008810002
2533
PAHRUL
PESERTA
10/08/1981
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,712 0001604325971 1901048012830001
2533
DEWI NATALIA
ISTRI
20/12/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,713 0001604325982 1901041408050007
2533
AGUS RIYADI
ANAK
14/08/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,714 0001604325993 1901042806110001
2533
QODRI
ANAK
28/06/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,715 0001604326004 1901040107860059
2537
SUBANDI
PESERTA
10/06/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,716 0001604326015 1901044107900075
2537
SUSILA WATI
ISTRI
08/02/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,717 0001604326026 1901043103100002
2537
ZIAN SOHARI
ANAK
31/03/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,718 0001604326037 1901045201130002
2537
NAZAROTUL PAZIRA
ANAK
12/01/2013
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,719 0001604326048 1901040103860001
2541
MAHDONI
PESERTA
01/03/1986
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,720 0001604326059 1901045506870005
2541
YUNIATI
ISTRI
15/06/1967
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,721 0001604326061 1901046010080001
2541
YESI AULIA YUDANI
ANAK
20/10/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 336 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,722 0001604326072 1901040707850008
2544
HOLDEN
PESERTA
07/07/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,723 0001604326083 1901046505880002
2544
MARIA
ISTRI
25/05/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,724 0001604326094 1901040311080001
2544
HALISKI FIRANDA
ANAK
03/11/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,725 0001604326105 1901044311130001
2544
RANIA
ANAK
03/11/2013
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,726 0001604326116 1901040606820003
2548
ZOHRI
PESERTA
06/06/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,727 0001604326127 1901044505880004
2548
SARI DONA
ISTRI
05/05/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,728 0001604326138 1901046703090001
2548
ANGGITA LESTARI
ANAK
27/03/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,729 0001604326149 1901041002800001
2551
TIBRONI
PESERTA
10/02/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,730 0001604326151 1901045305810003
2551
MARSAH
ISTRI
13/05/1981
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,731 0001604326162 1901040606050004
2551
MUHAMMAD GUNAWAN
ANAK
06/06/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,732 0001604326173 1901040307060003
2551
MAHDODI
ANAK
03/07/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,733 0001604326184 1901045608120004
2551
FITRIYANI
ANAK
16/08/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,734 0001604326195 1901040603830002
2556
SAMAR GANDI
PESERTA
05/03/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,735 0001604326206 1901045105870012
2556
ANITA PITRIA
ISTRI
11/05/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,736 0001604326217 1901044310110001
2556
HAYATUL HUSNA
ANAK
03/10/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,737 0001604326228 1901042006850002
2560
SAHRUL ABIDIN
PESERTA
20/06/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,738 0001604326239 1901045512860002
2560
UMMI KALSUM
ISTRI
15/12/1986
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,739 0001604326241 1901046109080001
2560
HESTI ANANDA
ANAK
21/09/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,740 0001604326252 1901040107830003
2563
ISMULKANDI
PESERTA
01/07/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,741 0001604326263 1901045605840002
2563
SUMARTI
ISTRI
16/05/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,742 0001604326274 1901044510080003
2563
JUWITA LESTARI
ANAK
05/10/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,743 0001604326285 1901042704130001
2563
LISDIANTO
ANAK
27/04/2013
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,744 0001604326296 1901041112690001
2567
RAUDAH
PESERTA
11/12/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 337 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,745 0001604326307 1901046512050005
2567
CICI KUMALA SARI
ANAK
25/12/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,746 0001604326318 1901041007800006
2570
SAWAL
PESERTA
10/07/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,747 0001604326329 1901045001810001
2570
SURINA
ISTRI
10/01/1981
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,748 0001604326331 1901045202060004
2570
NURPAIZAH
ANAK
12/02/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,749 0001604326342 1901041502090002
2570
BIONDA JOHAN ANGGARA
ANAK
15/02/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,750 0001604326353 1901041304820002
2574
JOHAN WAHYUDI
PESERTA
13/04/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,751 0001604326364 1901044805860003
2574
SATYA LISTINA
ISTRI
08/05/1986
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,752 0001604326375 1901046209080003
2574
DESKA WULANDARI
ANAK
22/09/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,753 0001604326386 1901044203110000
2574
LESTI AMELIA
ANAK
02/03/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,754 0001604326397 1901044505740005
2582
SITI ZAINAB
PESERTA
05/05/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,755 0001604326408 1901046806950004
2582
SURIPA AWLIANA
ANAK
28/06/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,756 0001604326419 1901042401820005
2588
HERMAN P
PESERTA
24/01/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,757 0001604326421 1901046004790002
2588
ELMIYATI
ISTRI
20/04/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,758 0001604326432 1901045011000007
2588
DEVI PURWATI
ANAK
10/11/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,759 0001604326443 1901041207120001
2588
MAULANA SAPUTRA
ANAK
12/07/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,760 0001604326454 1901040504560002
2592
MAT ADON
PESERTA
05/04/1956
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,761 0001604326465 1901044703730001
2592
SITI PATIMAH
ISTRI
07/03/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,762 0001604326476 1901040412950002
2592
JUNAIDI
ANAK
04/12/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,763 0001604326487 1901041603000004
2592
MULYADI
ANAK
16/03/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,764 0001604326498 1901040303110001
2592
M.TANZI ILAHIROBBI
ANAK
03/03/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,765 0001604326509 1901041704690002
2598
ABDUL RASID
PESERTA
17/04/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,766 0001604326511 1901044902720001
2598
JAMALIAH
ISTRI
09/02/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,767 0001604326522 1901045107910001
2598
ELVERA
ANAK
11/07/1991
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 338 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,768 0001604326533 1901042709930003
2598
ANDRIAN PAHMI
ANAK
27/09/1993
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,769 0001604326544 1901041107950001
2598
ANDRI AZAN
ANAK
11/07/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,770 0001604326555 1901044209970002
2598
SOBIATUN NAJA
ANAK
02/09/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,771 0001604326566 1901044908060003
2598
MIA RIZKIA
ANAK
09/08/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,772 0001604326577 1901040209720004
2605
AZIM
PESERTA
02/09/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,773 0001604326588 1901045506750001
2605
IDAWAN
ISTRI
15/06/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,774 0001604326599 1901040604980001
2605
REDI ANDRI FIRMANSYAH
ANAK
06/04/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,775 0001604326601 1901044612990003
2605
ANISA LESTARI
ANAK
06/12/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,776 0001604326612 1901042001060003
2605
GIOVANI SETIAWAN
ANAK
20/01/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,777 0001604326623 1901041111730004
2610
BUSTOMI
PESERTA
11/11/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,778 0001604326634 1901044210830001
2610
ARJUNA
ISTRI
02/10/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,779 0001604326645 1901041201060001
2610
MUHAMMAD SAYYID ATTIJANI ANAK
12/01/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,780 0001604326656 1901044211090001
2610
WIRYA MAU'IZZOH
ANAK
18/05/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,781 0001604326667 1901040505740008
2620
ZAMZARI
PESERTA
05/05/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,782 0001604326678 1901044306740002
2620
SITI PATIMAH
ISTRI
03/06/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,783 0001604326689 1901045601960001
2620
SUSI HARYATI
ANAK
16/01/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,784 0001604326691 1901041106830002
2624
AHMAD ARPANDI
PESERTA
11/06/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,785 0001604326702 1901045010870006
2624
ATIYAH
ISTRI
10/10/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,786 0001604326713 1901044305090001
2624
PUTRI AURA
ANAK
03/05/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,787 0001604326724 1901040305760003
2627
SUKANDI
PESERTA
03/05/1976
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,788 0001604326735 1901045006800002
2627
PITRI YATI
ISTRI
10/06/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,789 0001604326746 1901047008060002
2627
MUQQODDI MQTUL MUHSINA
ANAK
30/08/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,790 0001604326757 1901040312680001
2630
BAHROIL
PESERTA
08/12/1968
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 339 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,791 0001604326768 1901044606700002
2630
URPAH
ISTRI
06/06/1970
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,792 0001604326779 1901048711890005
2630
DEVI APRIA
ANAK
27/11/1989
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,793 0001604326781 1901040405920081
2630
RESI SAHPUTRA
ANAK
04/05/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,794 0001604326792 1901040406000004
2630
BAYU GUNAWAN
ANAK
04/06/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,795 0001604326803 1901044909690001
2636
HENI SRI SURYANI
PESERTA
09/09/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,796 0001604326814 1901040505990003
2636
MUHAMMAD AGIL ADIBI
ANAK
05/05/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,797 0001604326825 1901044506700002
2644
HERILLIA
PESERTA
05/06/1970
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,798 0001604326836 1901040809900005
2644
HENDRI
ANAK
08/09/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,799 0001604326847 1901044101920006
2644
ASWA
ANAK
01/01/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,800 0001604326858 1901041304960001
2644
SUHAILI
ANAK
13/04/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,801 0001604326869 1901045504030004
2644
ATUL ADAWIYAH
ANAK
15/04/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,802 0001604326871 1901041010050008
2644
SAMAN HUDI
ANAK
10/10/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,803 0001604326882 1901042806630001
2650
SAMIRIN
PESERTA
28/06/1963
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,804 0001604326893 1901044102720003
2650
ROSIDAH
ISTRI
01/02/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,805 0001604326904 1901040709950003
2650
MULYONO
ANAK
07/09/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,806 0001604326915 1901041612010005
2650
RUDI ZULFITRI
ANAK
16/12/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,807 0001604326926 1901045007110001
2650
JULIA SAFITRI
ANAK
10/07/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,808 0001604326937 1901040710920004
2650
RENDYI JANUAR
ANAK
07/10/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,809 0001604326948 1901040103820005
2656
HERI MARZUAN
PESERTA
01/03/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,810 0001604326959 1901045408850003
2656
ROSILAWATI
ISTRI
14/08/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,811 0001604326961 1901046911110001
2656
RINA ANANDA
ANAK
29/11/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,812 0001604326972 1901040112730002
2659
HASAN AS'ARI
PESERTA
01/12/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,813 0001604326983 1901045505830001
2659
LILIS SURYANI
ISTRI
15/05/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 340 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,814 0001604326994 1901041408010001
2659
SOPWAN ZUHDI
ANAK
14/08/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,815 0001604327005 1901046009050001
2659
GINA AMELIA
ANAK
20/09/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,816 0001604327016 1901040109110001
2659
MUHAMMAD AIYDIL
ANAK
01/09/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,817 0001604327027 1901040811780002
2664
NAJAMUDIN
PESERTA
08/11/1978
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,818 0001604327038 1901044307850002
2664
SITI HASANAH
ISTRI
03/07/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,819 0001604327049 1901047112040001
2664
NIA ROBIATI
ANAK
31/12/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,820 0001604327051 1901046601060001
2664
NUR FAIZATUZZUHRO
ANAK
25/01/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,821 0001604327062 1901046209100001
2664
ZAKIYANTUN NUFUS
ANAK
12/09/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,822 0001604327073 1901042404140001
2664
AHMAD SAHAL AMRI
ANAK
24/04/2014
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,823 0001604327084 1901044908810002
2670
M.HANDOKO
PESERTA
09/08/1981
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,824 0001604327095 1901045804830001
2670
MISYATI
ISTRI
18/04/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,825 0001604327106 1901040707020005
2670
NURDIN YULIANSYAH
ANAK
07/07/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,826 0001604327117 1901045409070001
2670
MITHA RAMADANI
ANAK
14/09/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,827 0001604327128 1901041708810003
2675
MUHAMAD KAMIL
PESERTA
17/08/1981
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,828 0001604327139 1901046508890001
2675
MUTOHHAROH
ANAK
25/08/1989
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,829 0001604327141 1901041604080001
2675
MUHAMMAD AHKAM
ANAK
18/04/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,830 0001604327152 1901041609140001
2675
MUHAMMAD ZAADI
ANAK
16/09/2014
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,831 0001604327163 1901040805640002
2679
IBKAR
PESERTA
08/05/1964
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,832 0001604327174 1901044904650001
2679
KHODIJAH
ISTRI
09/04/1965
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,833 0001604327185 1901040508920002
2679
AHMAD AL ADWI
ANAK
05/08/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,834 0001604327196 1901041209950003
2679
REZA KADAPI
ANAK
12/09/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,835 0001604327207 1901041805980005
2679
AHMAD SADLI
ANAK
18/05/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,836 0001604327218 1901040301040003
2679
TAJUDIN NUR
ANAK
03/01/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 341 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,837 0001604327229 1901042705780001
2685
AHMAD BAHRI
PESERTA
27/05/1978
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,838 0001604327231 1901044705820002
2685
NURHASANAH
ISTRI
07/05/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,839 0001604327242 1901042010030004
2685
ZAINUL KIROM
ANAK
20/10/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,840 0001604327253 1901046805080001
2685
ZAKWAH SALSABILA
ANAK
28/05/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,841 0001604327264 1901041705100001
2685
ZAMHARIRA
ANAK
17/05/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,842 0001604327275 1904012303860005
2693
AHMAD RIZKI
PESERTA
23/03/1986
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,843 0001604327286 1901046407900001
2693
MURSIDA
ISTRI
24/07/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,844 0001604327297 1901046907110001
2693
ZAHWA ADILA RISNI
ANAK
29/07/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,845 0001604327308 1901040107780036
2696
ASRODI
PESERTA
01/07/1978
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,846 0001604327319 1901044107800060
2696
MUHARNI
ISTRI
01/07/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,847 0001604327321 1901040302020002
2696
RISKI WAHYUDI
ANAK
03/02/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,848 0001604327332 1901041612070001
2696
APREZA
ANAK
16/12/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,849 0001604327343 1901040107730091
2700
ISWANDI
PESERTA
01/07/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,850 0001604327354 1901046502740001
2700
JIRMI
ISTRI
25/02/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,851 0001604327365 1901040705950003
2700
RADI YANTO
ANAK
07/05/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,852 0001604327376 1901040209970003
2700
AGUSTARI
ANAK
02/09/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,853 0001604327387 1901040909020005
2700
HELDIAN
ANAK
09/09/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,854 0001604327398 1901042905070001
2700
ARIF RAHMAN
ANAK
29/05/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,855 0001604327409 1901040404730002
2706
APENDI
PESERTA
04/04/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,856 0001604327411 1901044107680051
2706
MARIAH
ISTRI
01/07/1968
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,857 0001604327422 1901040808970002
2706
AGUS BUDIANSAH
ANAK
08/08/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,858 0001604327433 1901044401000001
2706
MERI HANDAYANI
ANAK
04/01/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,859 0001604327444 1901040805010001
2706
FEBRI SAPUTRA
ANAK
08/05/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 342 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,860 0001604327455 1901042312090028
2711
SAPARDI
PESERTA
26/09/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,861 0001604327466 1901044107730057
2711
SURYATI
ISTRI
01/07/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,862 0001604327477 1901046803950002
2711
ELYA FIFIYANTI
ANAK
28/03/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,863 0001604327488 1901041404970001
2711
ANDIKA PAHLIGA
ANAK
14/04/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,864 0001604327499 1901041307030004
2711
DENI ARYANSYAH
ANAK
13/07/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,865 0001604327501 1901041302690002
2716
AHMAD ZAKWAN
PESERTA
13/02/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,866 0001604327512 1901044107710085
2716
ZURYANI
ISTRI
01/07/1971
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,867 0001604327523 1901046212930002
2716
DESI RATNASARI
ANAK
22/12/1993
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,868 0001604327534 1901042111960003
2716
AHMAD SODRI
ANAK
29/09/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,869 0001604327545 1901045902990006
2716
LILIN PAUZIAH
ANAK
19/02/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,870 0001604327556 1901041006050003
2716
IMAM MUZADI
ANAK
06/10/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,871 0001604327567 1901043001070001
2716
IHSAN MUDIN
ANAK
30/01/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,872 0001604327578 1901040205660001
2723
ABDULLAH
PESERTA
02/05/1968
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,873 0001604327589 1901045406700002
2723
HAYATI
ISTRI
14/06/1970
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,874 0001604327591 1901041212900002
2723
BADRUL WADI
ANAK
12/12/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,875 0001604327602 1901044512000002
2723
RIKANIA
ANAK
05/12/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,876 0001604327613 1901040107650103
2731
JUNAIDI
PESERTA
01/07/1965
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,877 0001604327624 1901044107720110
2731
ZABANIAH
ISTRI
01/07/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,878 0001604327635 1901040805940002
2731
YUDI WAHYURI
ANAK
08/05/1994
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,879 0001604327646 1901040810950003
2731
ELI STRIYADI
ANAK
08/10/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,880 0001604327657 1901040310030002
2731
JULKIPLI
ANAK
03/10/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,881 0001604327668 1901042111790001
2736
KOMARUDIN
PESERTA
21/11/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,882 0001604327679 1901040904070003
2736
NEHA OLANDIA
ANAK
09/04/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 343 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,883 0001604327681 1901040512090002
2736
MUHAMMAD AIDIL ADHA
ANAK
05/12/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,884 0001604327692 1901046806990002
2736
RENILDA FILIAN DINI
TAMBAHAN
28/08/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,885 0001604327703 1901045310930002
2736
REVIYANDA SAPITRI
TAMBAHAN
13/10/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,886 0001604327714 1901042606860004
2742
AHMAD JUSWAN
PESERTA
26/06/1986
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,887 0001604327725 1901044209940004
2742
DIAN SAPUTRI
ISTRI
02/09/1994
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,888 0001604327736 1901042503130001
2742
MUHAMMAD RAYHAN
ANAK
25/03/2013
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,889 0001604327747 1901041108700004
2745
NAGA VALANTINO
PESERTA
11/08/1970
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,890 0001604327758 1901045307760002
2745
KUSUMA
ISTRI
13/07/1976
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,891 0001604327769 1901045512930002
2745
MEGA SERLEY NAWATI
ANAK
15/12/1993
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,892 0001604327771 1901042905970003
2745
HANDIKA PARYOGA
ANAK
29/05/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,893 0001604327782 1901042511040001
2745
YUDHA PRADIKA
ANAK
25/11/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,894 0001604327793 1901040311600001
2750
UDIN
PESERTA
03/11/1960
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,895 0001604327804 1901045507560001
2750
MARYATI
ISTRI
15/07/1956
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,896 0001604327815 1901042104750002
2750
ISWADI
ANAK
21/04/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,897 0001604327826 1901042407880001
2750
PIRDAN KHOIRI
ANAK
24/07/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,898 0001604327837 1901045602920003
2750
MILYANA
ANAK
16/02/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,899 0001604327848 1901040909740003
2755
M.GHOZALI
PESERTA
09/09/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,900 0001604327859 1901044508800003
2755
MARIA ULFA
ISTRI
05/08/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,901 0001604327861 1901045212010004
2755
SAIDATUL MUKARROMAH
ANAK
12/12/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,902 0001604327872 1901040711030003
2755
RIDOURROHMAN
ANAK
07/11/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,903 0001604327883 1901046701060004
2755
MARYATUL ASLAMIYAH
ANAK
27/01/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,904 0001604327894 1901045004720003
2768
ERYANI
PESERTA
10/04/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,905 0001604327905 1901040803940002
2768
RIJALUL HUSNI
ANAK
08/03/1994
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 344 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,906 0001604327916 1901046505970002
2768
NURHALIZA
ANAK
25/05/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,907 0001604327927 1901042202030004
2768
YUDA AKBAR
ANAK
22/02/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,908 0001604327938 1901041205800002
2772
HOIRUL PADILAH
PESERTA
12/05/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,909 0001604327949 1901044903850001
2772
MAMI
ISTRI
09/03/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,910 0001604327951 1901041407050002
2772
MUHAMMAD PATHAN
ANAK
14/07/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,911 0001604327962 1901046306090001
2772
MARATUL ASLAMIYAH
ANAK
23/06/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,912 0001604327973 1901040305580001
2776
HUZAIRI
PESERTA
03/05/1958
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,913 0001604327984 1901044706620001
2776
HODIJAH
ISTRI
07/06/1962
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,914 0001604327995 1901046403970003
2776
HIJRAH SAFITRI
ANAK
24/03/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,915 0001604328006 1901040106670002
2779
MAHZUNI
PESERTA
01/06/1967
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,916 0001604328017 1901045506690001
2779
ROSILAWATI
ISTRI
15/06/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,917 0001604328028 1901046707930002
2779
KHOIROTUNNISA
ANAK
24/07/1993
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,918 0001604328039 1901041302950002
2779
IKHSANUL QOLBI
ANAK
13/02/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,919 0001604328041 1901041701990004
2779
MUHAMMAD FIKRI
ANAK
17/01/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,920 0001604328052 1901047112000002
2779
FITRIATUL UZMA
ANAK
31/12/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,921 0001604328063 1901042711040001
2779
SALIM MUSTHOPA
ANAK
27/11/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,922 0001604328074 1901042605750001
2786
AJAT SUDRAJAT
PESERTA
26/05/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,923 0001604328085 1901044508870004
2786
RIDA MANDA SARI
ISTRI
05/08/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,924 0001604328096 1901041601060003
2786
RIFKI ZULHAM
ANAK
16/01/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,925 0001604328107 1901041002760001
2789
SAIPUL BAHRI
PESERTA
10/02/1976
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,926 0001604328118 1901040303000002
2789
EMENDRA
ANAK
03/03/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,927 0001604328129 1901040110030003
2789
MESI IZANISTA
ANAK
01/10/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,928 0001604328131 1901040107570088
2793
PADHUL
PESERTA
01/07/1957
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 345 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,929 0001604328142 1901044107550052
2793
ZURIAH
ISTRI
01/07/1955
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,930 0001604328153 1901045203880001
2793
FITRI
ANAK
01/08/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,931 0001604328164 1901040107620113
2796
TARPI
PESERTA
01/07/1962
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,932 0001604328175 1901044107630107
2796
ROMAINAH
ISTRI
01/07/1963
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,933 0001604328186 1901045307930004
2796
TINI
ANAK
13/07/1993
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,934 0001604328197 1901042610970003
2796
SOBRI
ANAK
26/10/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,935 0001604328208 1901040904990005
2796
SAPRIYADI
ANAK
09/04/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,936 0001604328219 1901041306660001
2808
SANAWI
PESERTA
13/06/1966
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,937 0001604328221 1901046107750002
2808
YULYANA
ISTRI
11/07/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,938 0001604328232 1901040811070003
2808
M.PAISAL AKBAR
ANAK
08/11/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,939 0001604328243 1901048301960003
2808
SUSI SUSILAWATI
TAMBAHAN
23/01/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,940 0001604328254 1901041801610001
2812
MULYADI
PESERTA
18/01/1961
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,941 0001604328265 1901046505670002
2812
SITI MAWATI
ISTRI
25/05/1967
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,942 0001604328276 1901040707920002
2812
ADIF NOPAL
ANAK
07/07/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,943 0001604328287 1901045403940002
2812
MARDIATUL ATIAH
ANAK
14/03/1994
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,944 0001604328298 1901046509980001
2812
MIZATUS SOLEHA
ANAK
25/09/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,945 0001604328309 1901040107670115
2817
USMAN
PESERTA
01/07/1967
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,946 0001604328311 1901044301720003
2817
MUZAYANA
ISTRI
03/01/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,947 0001604328322 1901041902960003
2817
FITRI YANTO
ANAK
19/02/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,948 0001604328333 1901046102010003
2817
LITA LIA
ANAK
21/02/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,949 0001604328344 1901041103750005
2821
BUSNADI
PESERTA
11/03/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,950 0001604328355 1901045703730004
2821
ROMAILA
ISTRI
17/03/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,951 0001604328366 1901043108000003
2821
NAMLUL WADI
ANAK
31/08/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 346 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,952 0001604328377 1901045011020003
2821
INDRI MARYANI
ANAK
10/11/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,953 0001604328388 1901044803110001
2821
AYATUL HUSNA
ANAK
08/03/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,954 0001604328399 1901042101860003
2826
RASKI BAYUNI
PESERTA
21/01/1986
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,955 0001604328401 1901045605870002
2826
RISTINA
ISTRI
16/05/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,956 0001604328412 1901046504120001
2826
KHAWLA ALICIA
ANAK
25/04/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,957 0001604328423 1901041707720001
2829
SUBARI
PESERTA
17/07/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,958 0001604328434 1901045101740001
2829
IDA WATI
ISTRI
11/01/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,959 0001604328445 1901041112960001
2829
BASTIAN JUNAIDI
ANAK
11/12/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,960 0001604328456 1901040207000001
2829
ILHAM NAFIZI
ANAK
02/07/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,961 0001604328467 1901045006080002
2829
NILAM CAHYA
ANAK
10/06/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,962 0001604328478 1901040810490001
2834
TORODI
PESERTA
08/10/1949
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,963 0001604328489 1901045209500001
2834
JASMIAH
ISTRI
12/09/1950
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,964 0001604328491 1901042211870002
2834
AHMAD MUKHTAROM
ANAK
22/11/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,965 0001604328502 1901040708890002
2834
USMAN ZINNUROINI
ANAK
07/08/1989
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,966 0001604328513 1901041403740002
2838
AMRULLAH
PESERTA
14/03/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,967 0001604328524 1901045209740001
2838
RISMA FITRI
ISTRI
12/09/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,968 0001604328535 1901046403980001
2838
ERISKA ANGGRAINI PUTRI
ANAK
24/03/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,969 0001604328546 1901042501040001
2838
VINA AULIA
ANAK
25/01/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,970 0001604328557 1901041904110001
2838
MUHAMMAD FAHRIZI AKBAR
ANAK
19/04/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,971 0001604328568 1901041001620001
2843
BASTARI
PESERTA
10/01/1962
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,972 0001604328579 1901045809660001
2843
MASAMAH
ISTRI
18/09/1966
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,973 0001604328581 1901041407890001
2843
ZILMAN
ANAK
14/07/1989
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,974 0001604328592 1901042312900002
2843
BAHRI RUSMAN
ANAK
23/12/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 347 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,975 0001604328603 1901046706930001
2843
MUTIARSI
ANAK
27/06/1993
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,976 0001604328614 1901041312960001
2843
DEKI
ANAK
13/12/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,977 0001604328625 1901045508980002
2843
SINTA
ANAK
15/08/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,978 0001604328636 1901040105000002
2843
HENDI
ANAK
01/05/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,979 0001604328647 1901040908080001
2843
ARGA SUJANA
ANAK
09/08/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,980 0001604328658 1901041611630001
2854
BASTAMI
PESERTA
15/11/1963
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,981 0001604328669 1901046702560001
2854
TAMIAH
ISTRI
27/02/1956
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,982 0001604328671 1901040808920004
2854
MUHAMAD INSAN
ANAK
08/06/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,983 0001604328682 1901041605850003
2857
SATRI
PESERTA
16/05/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,984 0001604328693 1901045005920002
2857
RITA LISMAYA
ISTRI
10/05/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,985 0001604328704 1901045508110002
2857
RAHMA WATI
ANAK
15/08/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,986 0001604328715 1901040107580078
2860
SAIDI
PESERTA
01/07/1958
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,987 0001604328726 1901044107630093
2860
ARNITA
ISTRI
01/07/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,988 0001604328737 1901041311850002
2860
AHMAD HAFIZI
ANAK
13/11/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,989 0001604328748 1901044101870006
2860
SARI YULYATI
ANAK
01/01/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,990 0001604328759 1901042211880002
2860
ROBI HANDALA
ANAK
22/11/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,991 0001604328761 1901044119000006
2860
DEVI ELSA
ANAK
01/11/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,992 0001604328772 1901046309920001
2860
RURIN SEPTIRA
ANAK
23/09/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,993 0001604328783 1901045505960005
2860
SITI KARMILA
ANAK
15/05/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,994 0001604328794 1901040104980004
2860
KHOIRUL ADHA
ANAK
01/04/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,995 0001604328805 1901040107660059
2869
SUBARKAT
PESERTA
01/07/1966
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,996 0001604328816 1901044509680005
2869
SRIYANI
ISTRI
05/09/1968
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,997 0001604328827 1901042008900004
2869
AHMAD SUBARI
ANAK
20/08/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 348 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
7,998 0001604328838 1901041411930002
2869
AHMAD TAUFIK
ANAK
14/11/1993
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
7,999 0001604328849 1901045409990001
2869
RIA SARI
ANAK
14/09/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,000 0001604328851 1901045112040002
2869
RINA
ANAK
11/12/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,001 0001604328862 1901046203070006
2869
RANI
ANAK
22/03/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,002 0001604328873 1901041104110002
2869
RIZKI AFRIADI
ANAK
11/04/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,003 0001604328884 1901041907530002
2877
MAS'UT
PESERTA
19/07/1953
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,004 0001604328895 1901045901590001
2877
SURAYAH
ISTRI
19/01/1959
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,005 0001604328906 1901044601880002
2877
DIANSARI
ANAK
06/01/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,006 0001604328917 1901041302900004
2877
JULAI
ANAK
13/02/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,007 0001604328928 1901040407910003
2877
KALOK
ANAK
04/07/1991
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,008 0001604328939 1901045211920002
2877
EVI
ANAK
12/11/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,009 0001604328941 1901045310940005
2877
LARA
ANAK
13/10/1994
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,010 0001604328952 1901046012960005
2877
NIA
ANAK
20/12/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,011 0001604328963 1901042301880001
2885
WAHYU HIDAYAT
PESERTA
23/01/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,012 0001604328974 1901046711910002
2885
NUTIA SARI
ISTRI
28/11/1991
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,013 0001604328985 1901041212110002
2885
ROHIL ALGIFARI
ANAK
12/12/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,014 0001604328996 1901042107690001
2888
AHMAD NAZORI
PESERTA
21/07/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,015 0001604329007 1901040401000001
2888
MUHAMAD RIZKI
ANAK
04/01/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,016 0001604329018 1901042006880003
2890
AMIRUDIN
PESERTA
20/06/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,017 0001604329029 1903015805890002
2890
SITI HALIFAH
ISTRI
18/05/1989
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,018 0001604329031 1901040802140001
2890
MUHAMMAD CHANDRA
ANAK
08/02/2014
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,019 0001604329042 1903017005080003
2890
PERLIN
TAMBAHAN
30/05/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,020 0001604329053 1901041205840003
2894
EFENDI
PESERTA
12/05/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 349 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,021 0001604329064 1901044501910003
2894
DESI MULYA SARI
ISTRI
05/01/1991
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,022 0001604329075 1901047005120002
2894
SISILIA FENDRI
ANAK
30/05/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,023 0001604329086 1901040506790004
2897
MUHAMMAD ARUP
PESERTA
05/06/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,024 0001604329097 1901044112830001
2897
YULITA
ISTRI
01/12/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,025 0001604329108 1901041507030003
2897
MUHAMMAD PADLI
ANAK
15/07/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,026 0001604329119 1901041712120001
2897
MUHAMMAD PADHAN
ANAK
17/12/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,027 0001604329121 1901040703690003
2901
JUMANRIADI
PESERTA
07/03/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,028 0001604329132 1901044409710002
2901
NURHANA
ISTRI
04/09/1971
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,029 0001604329143 1901040207040004
2901
YULIANTO
ANAK
02/07/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,030 0001604329154 1901045311090002
2901
MUSLIMAH
ANAK
13/11/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,031 0001604329165 1901040204450001
2906
SEMA'UN
PESERTA
02/04/1945
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,032 0001604329176 1901044109500001
2906
SAUDAH
ISTRI
01/09/1950
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,033 0001604329187 1901040409860002
2906
ABDI CAHYADI
ANAK
04/09/1986
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,034 0001604329198 1901041707730002
2909
LUKMAN HAKIM
PESERTA
17/07/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,035 0001604329209 1901046607760001
2909
HERMIYATI
ISTRI
26/07/1976
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,036 0001604329211 1901042206010002
2909
JODI AFRIANTO
ANAK
22/06/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,037 0001604329222 1901042212030001
2909
IBNUL HAMDI
ANAK
22/12/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,038 0001604329233 1901047110080001
2909
ZIMA OKTAVIA
ANAK
31/10/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,039 0001604329244 1901042401790001
2914
AHMAD BARIZI
PESERTA
24/01/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,040 0001604329255 1901045012870005
2914
EPI SURYA DEWI
ISTRI
10/12/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,041 0001604329266 1901041809110002
2914
DIMAS ARDIANSYAH
ANAK
18/09/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,042 0001604329277 1901042906590001
2917
SARWANI
PESERTA
29/06/1959
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,043 0001604329288 1901044504600003
2917
MARINI
ISTRI
05/04/1960
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 350 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,044 0001604329299 1901040906880010
2917
HERI ANGGARA
ANAK
09/06/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,045 0001604329301 1901046405990001
2917
SARTIKA DARA SYAKILA
ANAK
24/05/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,046 0001604329312 1901041603830001
2921
Mardani
PESERTA
16/03/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,047 0001604329323 1901044312880003
2921
Nana
ISTRI
03/12/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,048 0001604329334 1901041503570002
2923
Muhammad Yusuf
PESERTA
15/03/1957
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,049 0001604329345 1901046204570002
2923
Fatimah
ISTRI
22/04/1957
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,050 0001604329356 1901045507700003
2927
Sumarni
PESERTA
15/07/1970
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,051 0001604329367 1901043112670003
2930
Sumarli
PESERTA
31/12/1967
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,052 0001604329378 1901047112720009
2930
Noryani
ISTRI
31/12/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,053 0001604329389 1901042804761801
2932
Solihin
PESERTA
28/04/1976
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,054 0001604329391 1901046306891801
2932
Dariyus
ISTRI
23/06/1989
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,055 0001604329402 1901041308600001
2934
Muhamad din
PESERTA
13/08/1960
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,056 0001604329413 1901044807840001
2934
Romlah
ISTRI
08/07/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,057 0001604329424 1901040403690002
2936
Hasan basri
PESERTA
04/03/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,058 0001604329435 1901045201710004
2936
Saridah
ISTRI
12/01/1971
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,059 0001604329446 1901040107700095
2938
Yusuf
PESERTA
01/07/1970
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,060 0001604329457 1901045905680001
2938
Sakniah
ISTRI
19/05/1968
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,061 0001604329468 1901045002730001
2940
Murtina
PESERTA
10/02/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,062 0001604329479 1901041403700002
2941
latip
PESERTA
30/12/1959
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,063 0001604329481 1901046007700002
2941
Aida
ISTRI
20/07/1970
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,064 0001604329492 1901041608880001
2941
Angga
ANAK
16/11/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,065 0001604329503 1901945103630001
2944
Nurhayati
PESERTA
11/03/1963
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,066 0001604329514 1901040303750003
2947
Romlan
PESERTA
03/03/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 351 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,067 0001604329525 1901040509850001
2947
Farina
ISTRI
25/09/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,068 0001604329536 1901014010740031
2952
ABDUL MALEK
PESERTA
01/07/1943
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,069 0001604329547 1901040807410001
2953
RASID
PESERTA
08/07/1941
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,070 0001604329558 1901040107590058
2954
JONI
PESERTA
01/07/1959
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,071 0001604329569 1901040107320001
2955
ABU
PESERTA
01/07/1932
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,072 0001604329571 1901040708620006
2956
SALEH
PESERTA
07/08/1962
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,073 0001604329582 1901043101600001
2958
SYAFRIZAL
PESERTA
31/01/1960
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,074 0001604329593 1901041010600004
2960
ZULKIPLI
PESERTA
10/10/1960
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,075 0001604329604 1901040105710001
2961
SAFUAN AZHARI
PESERTA
01/05/1971
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,076 0001604329615 1971010301820004
3013
FERIYANTO
PESERTA
03/01/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,077 0001604329626 1901045001910005
3013
HARIA MURNI
ISTRI
10/01/1991
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,078 0001604329637 1901041104110001
3013
GAVRIEL ARGA ARDHANI
ANAK
11/04/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,079 0001604329648 1901042405810003
3021
Dukaria
PESERTA
24/05/1981
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,080 0001604329659 1901045207870003
3021
Julianti
ISTRI
12/07/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,081 0001604329661 1901042808040004
3021
Muhammad anggi
ANAK
28/08/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,082 0001604329672 1901044508060003
3021
Nur azizah
ANAK
05/05/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,083 0001604329683 1901041509640002
3025
Ishak
PESERTA
15/09/1964
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,084 0001604329694 1901044506730002
3025
Zaimah
ISTRI
15/06/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,085 0001604329705 1901046112040001
3025
Intan nuraini
ANAK
21/12/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,086 0001604329716 1901042112100003
3025
Muhammad reihan
ANAK
21/12/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,087 0001604329727 1901041008500003
3034
Abdullah Muhtasyor
PESERTA
10/08/1950
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,088 0001604329738 1901044204520001
3034
Hukmiah
ISTRI
02/04/1952
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,089 0001604329749 1901041003890003
3034
Mahmud
ANAK
10/03/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 352 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,090 0001604329751 1901040107770044
3037
Hayazi
PESERTA
01/07/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,091 0001604329762 1901044107830001
3037
NURAINI
ISTRI
10/07/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,092 0001604329773 1901044710040001
3037
Meri dahlia
ANAK
01/07/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,093 0001604329784 1901044608070002
3037
Jupita sari
ANAK
01/07/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,094 0001604329795 1901045806120002
3037
Juwida
ANAK
18/05/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,095 0001604329806 1901040303630001
3042
Kitman
PESERTA
03/03/1963
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,096 0001604329817 1901044408010003
3042
Maskanah
ANAK
20/08/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,097 0001604329828 1901042708040003
3042
Subandari
ANAK
27/08/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,098 0001604329839 1901040909590001
3047
Sulaiman
PESERTA
09/09/1959
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,099 0001604329841 1901045610730001
3047
Yusnita
ISTRI
18/10/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,100 0001604329852 1901042709020002
3047
Zulkarnain
ANAK
27/09/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,101 0001604329863 1901042903050001
3047
Abdul rohman
ANAK
29/03/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,102 0001604329874 1901040512120001
3047
Sabikah Fathin
ANAK
05/12/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,103 0001604329885 1901042013680001
3055
Sambiri
PESERTA
20/03/1968
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,104 0001604329896 1901044406710002
3055
Isna
ISTRI
04/06/1971
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,105 0001604329907 1901046008970001
3055
Siti aminah
ANAK
20/08/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,106 0001604329918 1901040704030005
3055
M. Azan
ANAK
07/04/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,107 0001604329929 1901042808050005
3055
M. Alimun hakim
ANAK
28/08/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,108 0001604329931 1901041202750003
3060
Hamzah
PESERTA
12/02/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,109 0001604329942 1901044502760002
3060
Halimah
ISTRI
05/02/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,110 0001604329953 1901044106050003
3060
Sumira
ANAK
01/06/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,111 0001604329964 1901041309080004
3060
Ahmad zawawi
ANAK
13/09/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,112 0001604329975 1901043107100003
3060
Abu daud
ANAK
31/07/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 353 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,113 0001604329986 1901040305370001
3065
Ahmad
PESERTA
03/05/1937
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,114 0001604329997 1901044506370001
3065
Isnaini
ISTRI
05/06/1937
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,115 0001604330008 1901040708920002
3065
Jum'at
ANAK
07/08/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,116 0001604330019 1901041002700001
3068
alpian
PESERTA
10/02/1970
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,117 0001604330021 1901041606530001
3070
Zaimi
PESERTA
16/06/1953
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,118 0001604330032 1901044509640002
3070
Maryam
ISTRI
05/09/1964
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,119 0001604330043 1901040405760001
3070
Kardi
ANAK
21/03/1978
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,120 0001604330054 1901045704960001
3070
Habibah
ANAK
12/06/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,121 0001604330065 1901040107780057
3074
Muas
PESERTA
01/07/1978
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,122 0001604330076 1901044107860064
3074
Mega
ISTRI
01/07/1986
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,123 0001604330087 1901040107000069
3074
Mahmudin
ANAK
01/07/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,124 0001604330098 1901044107020049
3074
Siti rohmah
ANAK
01/07/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,125 0001604330109 1901044101040002
3074
Saryatul
ANAK
01/07/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,126 0001604330111 1901040107510023
3079
Sarmadi
PESERTA
01/07/1951
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,127 0001604330122 1901044107520030
3079
Hotijah
ISTRI
01/07/1952
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,128 0001604330133 1901042906790001
3081
Samsul bahri
PESERTA
29/06/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,129 0001604330144 1901046006840001
3081
Siti patimah
ISTRI
20/06/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,130 0001604330155 1901044604010001
3081
Afriza asuri
ANAK
06/05/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,131 0001604330166 1901045803030001
3081
Fitri maryanti
ANAK
18/03/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,132 0001604330177 1901042407060001
3081
Muhammad khoirul ihsan
ANAK
24/07/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,133 0001604330188 1901046001080001
3081
Latipatun hikmah
ANAK
20/01/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,134 0001604330199 1901040809120002
3081
Azka sabili
ANAK
08/09/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,135 0001604330201 1901040905140001
3081
Muhammad kamil
ANAK
08/05/2014
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 354 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,136 0001604330212 1901042005730003
3089
Johan
PESERTA
20/05/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,137 0001604330223 1901046002780003
3089
Masni
ISTRI
20/02/1978
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,138 0001604330234 1901041804960005
3089
Muhammad isro
ANAK
18/04/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,139 0001604330245 1901046507000003
3089
Megawana
ANAK
25/07/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,140 0001604330256 1901045905060001
3089
Husnatul hasanah
ANAK
19/05/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,141 0001604330267 1901042707740004
3094
Darwin
PESERTA
27/07/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,142 0001604330278 1901046711800001
3094
Hotijah
ISTRI
27/11/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,143 0001604330289 1901042702960002
3094
Muhammad riza fajri
ANAK
27/02/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,144 0001604330291 1901041201020006
3094
Muhammad pikriansyah
ANAK
12/01/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,145 0001604330302 1901041009040002
3094
Perdiansyah
ANAK
10/09/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,146 0001604330313 1901042210640001
3099
Firmansyah
PESERTA
22/10/1964
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,147 0001604330324 1901045008670002
3099
Juraidah
ISTRI
10/06/1967
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,148 0001604330335 1901040407010005
3099
M. Rizkiansah
ANAK
04/07/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,149 0001604330346 1901040107610076
3102
Junaidi
PESERTA
01/07/1961
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,150 0001604330357 1901044112700004
3102
Nila
ISTRI
01/12/1970
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,151 0001604330368 1901040707990005
3102
Kiki Suryadi
ANAK
07/07/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,152 0001604330379 1901040102020003
3102
Lili Kurniawan
ANAK
01/02/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,153 0001604330381 1901045406810005
3110
Musa fari
PESERTA
14/06/1981
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,154 0001604330392 1901045203710002
3110
Zainab
ISTRI
12/03/1971
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,155 0001604330403 1901045202000001
3110
Asmarita
ANAK
12/02/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,156 0001604330414 1901042206060006
3110
Muhammad alpian
ANAK
22/06/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,157 0001604330425 1901045412100002
3110
Zubaidah
ANAK
14/12/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,158 0001604330436 1901040808660005
3116
Ahyak udin
PESERTA
08/08/1966
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 355 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,159 0001604330447 1901044107720079
3116
Siti arpah
ISTRI
01/07/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,160 0001604330458 1901047007080003
3116
Siti aisah
ANAK
30/07/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,161 0001604330469 1901040610080001
3116
Andi ardiansyah
ANAK
06/10/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,162 0001604330471 1901044801130002
3116
Sulastri
ANAK
08/10/2013
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,163 0001604330482 1901040506870003
3121
Ahir
PESERTA
05/06/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,164 0001604330493 1901046204830002
3121
Apriana
ISTRI
22/04/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,165 0001604330504 1901045401100001
3121
Sariwulan
ANAK
14/01/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,166 0001604330515 1901041508620001
3124
Romli
PESERTA
15/08/1962
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,167 0001604330526 1901046204650001
3124
Hidayah
ISTRI
22/04/1965
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,168 0001604330537 1901041001940003
3124
Turmizi
ANAK
10/01/1994
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,169 0001604330548 1901046708960001
3124
Siti holijah
ANAK
27/08/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,170 0001604330559 1901040609010004
3124
Ahmad toni
ANAK
06/09/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,171 0001604330561 1901040505600001
3129
Bandi
PESERTA
05/06/1960
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,172 0001604330572 1901044107750122
3129
Kamisah
ISTRI
01/07/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,173 0001604330583 1901040604680001
3131
Abidin
PESERTA
06/04/1968
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,174 0001604330594 1901045904650001
3131
Siti patimah
ISTRI
19/04/1965
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,175 0001604330605 1901046304920001
3131
Peti
ANAK
23/04/1992
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,176 0001604330616 1901046802950002
3131
Siti aminah
ANAK
28/02/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,177 0001604330627 1901045702330001
3131
Siti aisah
TAMBAHAN
17/02/1933
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,178 0001604330638 1901041507430001
3136
Dani
PESERTA
15/07/1943
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,179 0001604330649 1901044505460001
3136
Zaliha
ISTRI
05/05/1946
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,180 0001604330651 1901042102890003
3136
Sahud
ANAK
21/02/1989
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,181 0001604330662 1901040707850007
3139
Kamarudin
PESERTA
07/07/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 356 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,182 0001604330673 1901046302860003
3139
Solbiah
ISTRI
23/02/1986
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,183 0001604330684 1901046304090001
3139
Sopiah mahdiah
ANAK
23/04/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,184 0001604330695 1901040405100001
3139
Muhammad jumaidil
ANAK
04/05/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,185 0001604330706 1901040708640002
3143
Hajri
PESERTA
07/08/1964
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,186 0001604330717 1901044909620004
3143
Patimah
ISTRI
09/09/1962
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,187 0001604330728 1901040408910001
3143
Abdurrohim
ANAK
30/03/1991
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,188 0001604330739 1901040708930005
3143
Muhammad barizi
ANAK
07/08/1993
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,189 0001604330741 1901045007950001
3143
Zuriah
ANAK
10/07/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,190 0001604330752 1901040107680062
3152
Yunus
PESERTA
01/07/1968
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,191 0001604330763 1901045904840001
3152
Rismawati
ISTRI
19/04/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,192 0001604330774 1901044812080001
3152
Shodikoh
ANAK
08/12/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,193 0001604330785 1901044812080002
3152
Shofiah
ANAK
08/12/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,194 0001604330796 1901045202110002
3152
Khoirunnisa
ANAK
12/02/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,195 0001604330807 1901043007860001
3157
Hadirin
PESERTA
30/07/1986
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,196 0001604330818 1901044405890003
3157
Siti sarah
ISTRI
04/05/1989
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,197 0001604330829 1901042605090001
3157
Muhamad soleh
ANAK
26/05/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,198 0001604330831 1901046802110001
3157
Siti holipah
ANAK
28/02/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,199 0001604330842 1901044909130002
3157
Siti patimah
ANAK
09/09/2013
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,200 0001604330853 1901041903790001
3162
Abdul mutolip
PESERTA
19/03/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,201 0001604330864 1901044808740002
3162
Susilawati
ISTRI
08/08/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,202 0001604330875 1901040505000002
3162
Jumedi
ANAK
05/05/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,203 0001604330886 1901040107510032
3162
Muhammad
ANAK
01/07/1951
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,204 0001604330897 1901041806470001
3166
Dimroh
PESERTA
18/06/1947
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 357 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,205 0001604330908 1901044807550001
3166
Yahuti
ISTRI
08/07/1955
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,206 0001604330919 1901041508750001
3166
Yuhandi
ANAK
15/08/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,207 0001604330921 1901044309030001
3166
Sapinatul hasanah
ANAK
03/09/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,208 0001604330932 1901044606780004
3166
Mindarsih
TAMBAHAN
06/06/1978
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,209 0001604330943 1901040510680001
3171
Sawal
PESERTA
05/10/1968
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,210 0001604330954 1901044707770007
3171
Zaimah
ISTRI
07/07/1977
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,211 0001604330965 1901044802070003
3171
Rojmah
ANAK
08/02/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,212 0001604330976 1901040301090002
3171
Paidurrahman
ANAK
03/01/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,213 0001604330987 1901046207100001
3171
Marwah
ANAK
22/07/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,214 0001604330998 1901044305630001
3176
Saidah
PESERTA
03/05/1963
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,215 0001604331009 1901041512790003
3181
Ma'rup
PESERTA
15/12/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,216 0001604331011 1901045507820001
3181
Siti hozaipah
ISTRI
15/07/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,217 0001604331022 1901046003000002
3181
Siti rahmiyati
ANAK
06/11/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,218 0001604331033 1901044106030004
3181
Julia lestari
ANAK
01/06/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,219 0001604331044 1901041408070004
3181
Muhammad pajri
ANAK
14/08/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,220 0001604331055 1901040107690070
3186
Juadi
PESERTA
01/07/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,221 0001604331066 1901044107750088
3186
Rohana
ISTRI
01/07/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,222 0001604331077 1901046306060002
3186
Zainul jannah
ANAK
23/06/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,223 0001604331088 1901040402090001
3186
ahmad dairobi
ANAK
04/02/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,224 0001604331099 1901045609120002
3186
Nur fikazaharol jannah
ANAK
16/09/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,225 0001604331101 1901042904530001
3191
Jaimin
PESERTA
29/04/1953
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,226 0001604331112 1901044707560001
3191
Sopiah
ISTRI
07/07/1956
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,227 0001604331123 1901041904010001
3191
abdul mutholib
ANAK
19/04/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 358 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,228 0001604331134 1901040305520002
3194
Dulpakar
PESERTA
03/05/1952
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,229 0001604331145 1901045310530003
3194
Samsiah
ISTRI
13/10/1953
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,230 0001604331156 1901041705750001
3196
Asnawi
PESERTA
17/05/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,231 0001604331167 1901045507770003
3196
Aina
ISTRI
15/07/1977
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,232 0001604331178 1901045006030003
3196
dewi ratna sari
ANAK
10/06/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,233 0001604331189 1901040608070003
3196
Aswari
ANAK
06/08/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,234 0001604331191 1901040107650037
3200
Mustambi
PESERTA
05/08/1965
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,235 0001604331202 1901044107690035
3200
Romiah
ISTRI
06/04/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,236 0001604331213 1901040107890068
3200
Ibnu hajar
ANAK
06/07/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,237 0001604331224 1901040410700001
3204
Muhammad sopwan
PESERTA
10/10/1970
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,238 0001604331235 1901045307840001
3204
Sariatul mahdiah
ISTRI
13/07/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,239 0001604331246 1901045505050002
3204
Sa'adatul uzam
ANAK
15/05/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,240 0001604331257 1901041703070003
3204
Ahmad mujahidin
ANAK
17/03/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,241 0001604331268 1901046105090001
3204
Nurza hidah
ANAK
21/05/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,242 0001604331279 1901047101130001
3204
A'fifah
ANAK
31/01/2013
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,243 0001604331281 1901040107760052
3210
Zulman
PESERTA
01/07/1976
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,244 0001604331292 1901045204780002
3212
Asuma
PESERTA
12/04/1978
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,245 0001604331303 1901043112010002
3212
Irwansah
ANAK
31/12/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,246 0001604331314 1901042812080003
3212
Irpan
ANAK
28/12/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,247 0001604331325 1901044904110001
3212
Husna hotimah
ANAK
09/04/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,248 0001604331336 1901041408530001
3216
Antoni
PESERTA
14/08/1953
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,249 0001604331347 1901046204560001
3216
Saptiah
ISTRI
12/04/1958
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,250 0001604331358 1901041205970004
3216
Nurul habibi
ANAK
12/05/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 359 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,251 0001604331369 1901040603740002
3225
Ismail
PESERTA
06/03/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,252 0001604331371 1901041112070001
3225
Muhammad padli
ANAK
11/12/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,253 0001604331382 1901040107480001
3232
Zaman
PESERTA
01/07/1948
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,254 0001604331393 1901044107730001
3232
Serpah
ISTRI
01/07/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,255 0001604331404 1901040107060001
3232
Terajos
ANAK
01/07/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,256 0001604331415 1901040302680001
3235
Sutrisno
PESERTA
03/02/1968
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,257 0001604331426 1901044506750005
3235
Rohalia
ISTRI
05/06/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,258 0001604331437 1901046012990004
3235
Eka darmawan
ANAK
20/12/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,259 0001604331448 1901040409080001
3235
Erik
ANAK
04/09/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,260 0001604331459 1901061804690080
3240
Saipul
PESERTA
18/04/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,261 0001604331461 1901064910730001
3240
Mini
ISTRI
09/10/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,262 0001604331472 1901061909030001
3240
Sepri firmansyah
ANAK
19/09/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,263 0001604331483 1901044107620091
3246
Sauyah
PESERTA
01/07/1962
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,264 0001604331494 1901041008630001
3250
Amri
PESERTA
10/08/1963
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,265 0001604331505 1901044107780080
3250
Megawati
ISTRI
01/07/1978
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,266 0001604331516 1901040301070006
3250
kiki safitri
ANAK
03/01/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,267 0001604331527 1901042612100001
3250
Akbar ibrahim
ANAK
26/12/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,268 0001604331538 1901042009120001
3250
Albasi septiansyah
ANAK
26/09/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,269 0001604331549 1901040107720046
3257
Solihin
PESERTA
01/07/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,270 0001604331551 1901044107810041
3257
Juma'ani
ISTRI
10/09/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,271 0001604331562 1901040110070004
3257
Muhammad isa arbani
ANAK
01/10/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,272 0001604331573 1901047008090004
3257
Halimatussyakdiah
ANAK
30/08/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,273 0001604331584 1901044607110004
3257
Siti zulaiha
ANAK
08/07/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 360 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,274 0001604331595 1901040107650036
3262
Asnawi
PESERTA
01/07/1965
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,275 0001604331606 1901044509770001
3262
Subutiah
ISTRI
05/09/1977
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,276 0001604331617 1901044506980001
3262
Siti jami'ah
ANAK
05/06/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,277 0001604331628 1901046308990001
3262
Rosita
ANAK
23/08/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,278 0001604331639 1901042312050001
3262
M. Zarqhoni
ANAK
23/12/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,279 0001604331641 1901044301110002
3262
Zaharratul hotimah
ANAK
03/01/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,280 0001604331652 1901040209730004
3268
Azwandi
PESERTA
02/09/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,281 0001604331663 1901044107740054
3268
Saropiati
ISTRI
01/07/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,282 0001604331674 1901046204020002
3268
Yuni elpika
ANAK
22/04/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,283 0001604331685 1901042211040002
3268
Muhammad rizaldi
ANAK
22/11/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,284 0001604331696 1901041506070003
3268
M. Hapizul hikam
ANAK
15/06/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,285 0001604331707 1901042008090001
3268
Syahri mizar ramdani
ANAK
20/08/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,286 0001604331718 1901040107560054
3274
Ardi
PESERTA
01/07/1956
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,287 0001604331729 1901044805630001
3274
Hasmah
ISTRI
08/05/1963
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,288 0001604331731 1901044808960001
3274
Jama'ani
ANAK
08/08/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,289 0001604331742 1901040805040002
3274
Superiyadi
ANAK
08/05/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,290 0001604331753 1901041712070001
3274
Muhamad darsi
ANAK
17/12/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,291 0001604331764 1901041510620002
3279
Ismail
PESERTA
15/10/1962
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,292 0001604331775 1901046911640001
3279
Hapiah
ISTRI
29/11/1964
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,293 0001604331786 1901041204000001
3279
Kamaludin
ANAK
12/04/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,294 0001604331797 1901046006020002
3279
Zahratun jannah
ANAK
20/06/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,295 0001604331808 1901042603060003
3279
Haikal
ANAK
26/03/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,296 0001604331819 1901041605110001
3279
Arif
ANAK
16/05/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 361 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,297 0001604331821 1901040107400026
3285
Muhamad
PESERTA
01/01/1940
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,298 0001604331832 1901044107400027
3285
Maimunah
ISTRI
01/07/1940
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,299 0001604331843 1901044305710001
3288
Armia
PESERTA
03/05/1971
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,300 0001604331854 1901046207970002
3288
Sela zahara
ANAK
22/07/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,301 0001604331865 1901044704060003
3288
Sopiah
ANAK
07/04/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,302 0001604331876 1901041103080003
3288
Pirhan
ANAK
11/03/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,303 0001604331887 1901040107470027
3296
Kamis
PESERTA
01/07/1947
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,304 0001604331898 1901044107490017
3296
Subaidah
ISTRI
01/07/1949
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,305 0001604331909 1901045409980001
3296
Baiti
ANAK
14/09/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,306 0001604331911 1901040507640004
3299
Tahmid
PESERTA
05/07/1964
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,307 0001604331922 1901044402670002
3299
Rosmah
ISTRI
04/02/1967
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,308 0001604331933 1901042708980003
3299
Hoirul umam
ANAK
27/08/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,309 0001604331944 1901040804600002
3302
Saparudin
PESERTA
08/04/1960
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,310 0001604331955 1901044603630001
3302
Normala
ISTRI
06/03/1963
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,311 0001604331966 1901044811020002
3302
Asobah
ANAK
08/11/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,312 0001604331977 1901040902540001
3305
Marjan
PESERTA
09/02/1954
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,313 0001604331988 1901044407620002
3305
Saptiah
ISTRI
04/07/1962
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,314 0001604331999 1901040311950005
3305
Saripudin
ANAK
03/11/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,315 0001604332001 1901040508010001
3305
Rohim
ANAK
06/08/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,316 0001604332012 1901040107460016
3309
Subuh
PESERTA
01/07/1946
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,317 0001604332023 1901044107790058
3309
Robiyah
ISTRI
01/07/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,318 0001604332034 1901041604820005
3311
Juma'at
PESERTA
16/04/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,319 0001604332045 1901045307850004
3311
Nur halimah
ISTRI
13/07/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 362 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,320 0001604332056 1901042112040003
3311
Zaky saputra
ANAK
21/12/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,321 0001604332067 1901045810060002
3311
Sinta ulandari
ANAK
18/10/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,322 0001604332078 1901040209100002
3311
Imam sapi'i
ANAK
02/09/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,323 0001604332089 1901042402120001
3311
Muhammad sahdan
ANAK
24/02/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,324 0001604332091 1901041405720001
3317
Abu bakar
PESERTA
14/05/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,325 0001604332102 1901045807760001
3317
Siti asmani
ISTRI
18/07/1976
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,326 0001604332113 1901045001020002
3317
Juma'ah
ANAK
10/01/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,327 0001604332124 1901040510040002
3317
Abdul holil
ANAK
05/10/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,328 0001604332135 1901040606060002
3317
M. Syufi
ANAK
06/06/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,329 0001604332146 1901042212070001
3317
Hoirul adha
ANAK
22/12/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,330 0001604332157 1901040107490001
3323
Abdullah
PESERTA
01/07/1949
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,331 0001604332168 1901044107630001
3323
Rosidah
ISTRI
01/07/1963
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,332 0001604332179 1901044107910001
3323
Suryati
ANAK
01/07/1991
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,333 0001604332181 1901040107970001
3323
Yadi
ANAK
01/07/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,334 0001604332192 1901040107990001
3323
Aven
ANAK
01/07/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,335 0001604332203 1901040405830001
3333
Amran
PESERTA
04/05/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,336 0001604332214 1901044107900056
3333
Mahmudah
ISTRI
01/07/1990
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,337 0001604332225 1901042702080003
3333
Aidil barokah
ANAK
27/02/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,338 0001604332236 1901040108110001
3333
Sahri romadon
ANAK
01/08/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,339 0001604332247 1901042710120004
3333
Adha dulhaki
ANAK
27/10/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,340 0001604332258 1901040509500002
3338
Zainal
PESERTA
05/09/1950
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,341 0001604332269 1901045011560002
3338
Zauyah
ISTRI
10/11/1956
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,342 0001604332271 1901046008950007
3338
Pertiwi
ANAK
20/08/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 363 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,343 0001604332282 1901045904720002
3341
Asura
PESERTA
19/04/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,344 0001604332293 1901041105010001
3341
Ismaun
ANAK
11/05/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,345 0001604332304 1901045308070001
3341
Intan nuraini
ANAK
13/08/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,346 0001604332315 1901040107630075
3344
Samsudin
PESERTA
01/07/1963
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,347 0001604332326 1901045909690001
3344
Parida
ISTRI
19/09/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,348 0001604332337 1901045210940005
3344
Yuni asmawari
ANAK
12/10/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,349 0001604332348 1901042410000001
3344
Hariman As'ari
ANAK
24/10/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,350 0001604332359 1901044605040002
3344
Amelia suryana
ANAK
06/05/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,351 0001604332361 1901040703730003
3349
Idha holid
PESERTA
07/03/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,352 0001604332372 1901044408790002
3349
Erni yustina
ISTRI
04/08/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,353 0001604332383 1901044909010004
3349
Muzalipah
ANAK
09/09/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,354 0001604332394 1901044106060004
3349
Nur habibah
ANAK
01/06/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,355 0001604332405 1901040107480021
3361
Hasan
PESERTA
11/07/1948
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,356 0001604332416 1901044107530059
3361
Maji'ah
ISTRI
01/07/1953
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,357 0001604332427 1901040107880114
3361
Abdul sani
ANAK
01/07/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,358 0001604332438 1901044107300021
3361
Ning
ANAK
01/07/1930
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,359 0001604332449 1901040511580002
3365
Sudaidi
PESERTA
05/11/1958
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,360 0001604332451 1901044302590003
3365
Patimah
ISTRI
03/02/1959
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,361 0001604332462 1901045101940002
3365
Siti komariah
ANAK
11/01/1994
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,362 0001604332473 1901045601010001
3365
Umi habibah
ANAK
16/01/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,363 0001604332484 1901040107770113
3369
Ahmad nabawi
PESERTA
01/07/1977
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,364 0001604332495 1901044107850118
3369
Samsum komariah
ISTRI
01/07/1985
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,365 0001604332506 1901042103010004
3369
Ibrohim laqoni
ANAK
21/03/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 364 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,366 0001604332517 1901047011040002
3369
Nurhayati
ANAK
30/11/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,367 0001604332528 1901040510060003
3369
Syahrul ahmad
ANAK
02/10/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,368 0001604332539 1901044101090003
3369
Nurhakiki
ANAK
01/01/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,369 0001604332541 1901041308770003
3375
M. sakroni
PESERTA
13/08/1977
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,370 0001604332552 1901045810790001
3375
Haminok
ISTRI
18/10/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,371 0001604332563 1901041409050002
3375
M. sam zarkoni
ANAK
14/09/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,372 0001604332574 1901046203080003
3375
Toibus sariroh
ANAK
22/03/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,373 0001604332585 1901044202130004
3375
Siti khodijah
ANAK
02/02/2013
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,374 0001604332596 1901040107650005
3381
Hamidi
PESERTA
01/07/1965
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,375 0001604332607 1901044107710078
3381
Siti ropana
ISTRI
01/07/1971
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,376 0001604332618 1901041007910007
3381
Tarmizi
ANAK
10/07/1991
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,377 0001604332629 1901040107950003
3381
Abdullah
ANAK
01/07/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,378 0001604332631 1901040804740001
3392
Ependi
PESERTA
08/04/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,379 0001604332642 1901044202750004
3392
Yulita
ISTRI
02/02/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,380 0001604332653 1901045207980003
3392
Kika palisa
ANAK
12/07/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,381 0001604332664 1901042612000002
3392
Jeki subakti
ANAK
26/12/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,382 0001604332675 1901046503050001
3392
Assuna
ANAK
25/03/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,383 0001604332686 1901041006870008
3399
Edi candra
PESERTA
10/06/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,384 0001604332697 1901045111870005
3399
Noravika
ISTRI
11/11/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,385 0001604332708 1901043005070004
3399
Radit eka juni
ANAK
30/06/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,386 0001604332719 1901044406100002
3399
Junia sefiany
ANAK
04/05/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,387 0001604332721 1901040406740001
3404
Tabrozi
PESERTA
04/08/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,388 0001604332732 1901044109840005
3404
Norhana
ISTRI
01/09/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 365 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,389 0001604332743 1901046403120002
3404
Kalisa saputri
ANAK
24/03/2012
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,390 0001604332754 1901042007720003
3407
Arba'ani
PESERTA
20/07/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,391 0001604332765 1901046404730002
3407
Homsiah
ISTRI
24/04/1973
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,392 0001604332776 1901045004950004
3407
Aprilianingsih
ANAK
10/04/1995
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,393 0001604332787 1901045308010005
3407
Triade ningsih
ANAK
13/08/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,394 0001604332798 1901040405740002
3413
Samsuri
PESERTA
04/05/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,395 0001604332809 1901044107800099
3413
Erna
ISTRI
01/07/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,396 0001604332811 1901040508980003
3413
M. Abdul Aris
ANAK
05/08/1998
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,397 0001604332822 1901040607000003
3413
Mohamad aripin
ANAK
06/07/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,398 0001604332833 1901045507070006
3413
Salma
ANAK
15/07/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,399 0001604332844 1904031211770001
3418
Fahrulazi
PESERTA
12/11/1977
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,400 0001604332855 1901045703840002
3418
Megawati
ISTRI
17/03/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,401 0001604332866 1901047005130005
3418
Farunikha A
ANAK
30/05/2013
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,402 0001604332877 1901041006690002
3418
Otrimon pardi
TAMBAHAN
10/06/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,403 0001604332888 1901044702740004
3418
Aida
TAMBAHAN
07/02/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,404 0001604332899 1901046903080001
3418
Quratul hidayah
TAMBAHAN
29/03/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,405 0001604332901 1901043012690002
3424
Tarjukia
PESERTA
30/12/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,406 0001604332912 1901045503740003
3424
Patimah
ISTRI
15/03/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,407 0001604332923 1901045401970003
3424
Kismaya
ANAK
14/01/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,408 0001604332934 1901046403040002
3424
Nur habibah
ANAK
24/03/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,409 0001604332945 1901041309830002
3431
Mat tego
PESERTA
13/09/1983
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,410 0001604332956 1901046003810001
3431
Maisaroh
ISTRI
20/03/1981
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,411 0001604332967 1901040712030003
3431
Ariyadi
ANAK
07/12/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 366 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,412 0001604332978 1901040211060003
3431
Ferdiansyah
ANAK
02/11/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,413 0001604332989 1901040107430017
3435
Idris
PESERTA
01/07/1943
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,414 0001604332991 1901044107450020
3435
Asiah
ISTRI
01/07/1945
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,415 0001604333002 1901040107380007
3439
Amron
PESERTA
01/07/1938
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,416 0001604333013 1901044107390013
3439
Roihan
ISTRI
01/07/1939
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,417 0001604333024 1901040107820111
3442
Ibrahim
PESERTA
01/07/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,418 0001604333035 1901041312800001
3442
Zulkipli
ISTRI
13/12/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,419 0001604333046 1901044107540033
3445
Zauna
PESERTA
01/07/1954
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,420 0001604333057 1901044107420061
3446
Rohaya
PESERTA
01/07/1942
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,421 0001604333068 1901040107710076
3446
Pu'ad
SUAMI
01/07/1974
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,422 0001604333079 1901040107350023
3448
Muhammat
PESERTA
01/07/1935
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,423 0001604333081 1901044107380030
3448
Aisah
ISTRI
01/07/1938
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,424 0001604333092 1901045310720003
3448
Siti Nursa'diah
ANAK
13/10/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,425 0001604333103 1901042507820003
3453
Mahjub
PESERTA
25/07/1982
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,426 0001604333114 1901046712810002
3453
Zubaidah
ISTRI
27/12/1981
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,427 0001604333125 1901045712000005
3453
Yuni afira
ANAK
17/12/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,428 0001604333136 1901044606100003
3453
Aurel julyana
ANAK
06/06/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,429 0001604333147 1901041009700002
3457
Sukarman
PESERTA
10/09/1970
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,430 0001604333158 1901044107800089
3457
Martiah
ISTRI
01/07/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,431 0001604333169 1901045008020003
3457
Sapira puspa
ANAK
10/08/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,432 0001604333171 1901042410030002
3457
Alparizi
ANAK
24/10/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,433 0001604333182 1901040107560053
3461
Marhadi
PESERTA
01/07/1956
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,434 0001604333193 1901044107710075
3461
Yuhana
ISTRI
01/07/1971
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 367 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,435 0001604333204 1901045503990002
3461
Sofiatun
ANAK
15/03/1999
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,436 0001604333215 1901045207010003
3461
Nuraini
ANAK
12/07/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,437 0001604333226 1901040107560033
3465
Tolip
PESERTA
01/07/1956
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,438 0001604333237 1901042407620001
3468
Saha
PESERTA
24/07/1962
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,439 0001604333248 1901045812650001
3468
Siti
ISTRI
18/12/1965
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,440 0001604333259 1901042208750002
3470
Sahbudin
PESERTA
22/08/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,441 0001604333261 1901040202960001
3470
Fiki indrawan m
ANAK
02/02/1996
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,442 0001604333272 1901040510770001
3478
Zakaria
PESERTA
05/10/1977
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,443 0001604333283 1901046003800005
3478
Zaitun
ISTRI
20/03/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,444 0001604333294 1901044301000005
3478
Rovi yanti
ANAK
03/01/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,445 0001604333305 1901046701040002
3478
Lasmi
ANAK
27/01/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,446 0001604333316 1901044301080001
3478
Asmira Surita
ANAK
03/01/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,447 0001604333327 1901040102090001
3478
Nurul ikhsan
ANAK
01/02/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,448 0001604333338 1901040107680045
3486
Sudian
PESERTA
01/07/1968
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,449 0001604333349 1901044107590045
3486
Sopiah
ISTRI
01/07/1959
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,450 0001604333351 1901041609000001
3486
Samsul
ANAK
16/09/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,451 0001604333362 1901047009030002
3486
Saripah
ANAK
30/09/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,452 0001604333373 1901044107200007
3493
Fanzur
PESERTA
01/07/1920
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,453 0001604333384 1901044107450021
3494
Zalihah
PESERTA
01/07/1945
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,454 0001604333395 1901041302870002
3494
Roni
ANAK
13/02/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,455 0001604333406 1901042008690001
3497
Abidin
PESERTA
20/08/1969
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,456 0001604333417 1901044611750003
3497
Misnah
ISTRI
06/11/1975
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,457 0001604333428 1901042409940001
3497
Arjianto
ANAK
24/09/1994
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 368 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,458 0001604333439 1901041405970003
3497
Heri budiawan
ANAK
14/05/1997
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,459 0001604333441 1901042403010002
3497
Juhari
ANAK
24/03/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,460 0001604333452 1901041108060002
3497
Rahim sidik
ANAK
11/08/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,461 0001604333463 1901046803080001
3497
Virasti
ANAK
28/03/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,462 0001604333474 1901047112090001
3497
Meri arista
ANAK
31/12/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,463 0001604333485 1901044107420044
3497
Juma'ah
TAMBAHAN
01/07/1942
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,464 0001604333496 1901041504790003
3506
Helmi
PESERTA
15/04/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,465 0001604333507 1901041010030002
3506
Wahyudi
ANAK
10/10/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,466 0001604333518 1901041404050001
3506
Wahyono
ANAK
14/04/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,467 0001604333529 1901045504070004
3506
Santia
ANAK
15/04/2007
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,468 0001604333531 1901042408110002
3506
Amanulah
ANAK
24/08/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,469 0001604333542 1901042202710001
3512
Rendra n Lucky
PESERTA
22/02/1971
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,470 0001604333553 1901044107870099
3512
Tina sartika
ISTRI
01/07/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,471 0001604333564 1901041710020004
3512
Gusti partikaya
ANAK
17/10/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,472 0001604333575 1901046009040001
3512
Dewi dwipayana
ANAK
20/09/2004
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,473 0001604333586 1901044611060002
3512
Putri tiara pratiwi
ANAK
06/11/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,474 0001604333597 1901040107620082
3517
Tarmili
PESERTA
01/07/1977
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,475 0001604333608 1901044107690065
3517
Dirawati
ISTRI
08/04/1979
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,476 0001604333619 1901042007850003
3517
Suhendar
ANAK
08/08/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,477 0001604333621 1901042507870003
3517
Firmansyah
ANAK
09/03/2005
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,478 0001604333632 1901045805080002
3517
Sundari
ANAK
18/05/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,479 0001604333643 1901045110110006
3517
Siti khodijah
ANAK
11/10/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,480 0001604333654 1901040107540042
3523
Dul Mizi
PESERTA
01/07/1954
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 369 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,481 0001604333665 1901044107570078
3523
Romida
ISTRI
01/07/1957
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,482 0001604333676 1901040507800003
3523
Rosidi
ANAK
05/07/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,483 0001604333687 1901040107660034
3530
Jumlah
PESERTA
01/07/1966
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,484 0001604333698 1901044107670114
3530
Hotijah
ISTRI
01/07/1967
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,485 0001604333709 1901040204880001
3530
Azizi
ANAK
02/04/1988
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,486 0001604333711 1901044402000001
3530
Sarul
ANAK
04/02/2000
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,487 0001604333722 1901040809700002
3534
Ramlan
PESERTA
08/09/1970
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,488 0001604333733 1901044107800122
3534
Majiah
ISTRI
01/07/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,489 0001604333744 1901040509010005
3534
amir anwar
ANAK
05/09/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,490 0001604333755 1901042208020004
3534
Ahmed aris sabana
ANAK
22/08/2002
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,491 0001604333766 1901046701080001
3534
amalia riski
ANAK
27/07/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,492 0001604333777 1901044112100001
3534
Arbak
ANAK
01/12/2010
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,493 0001604333788 1901040703870007
3545
Ulul azmi
PESERTA
07/03/1987
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,494 0001604333799 1901047007940003
3545
Hendriyani
ISTRI
30/07/1994
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,495 0001604333801 1901045407110001
3545
Yulia lestari
ANAK
14/07/2011
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,496 0001604333812 1901040107500043
3549
Husen
PESERTA
01/07/1950
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,497 0001604333823 1901044107520047
3549
Arbi
ISTRI
01/07/1952
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,498 0001604333834 1901040107800107
3551
M. Dahlan
PESERTA
01/07/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,499 0001604333845 1901044101840001
3551
yuyun
ISTRI
01/01/1984
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,500 0001604333856 1901041512060001
3551
Jumaiyani
ANAK
15/12/2006
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,501 0001604333867 1901045112010003
3551
Sulastri
ANAK
11/12/2001
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,502 0001604333878 1901040107440012
3556
Jumri
PESERTA
01/07/1944
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,503 0001604333889 1901044107460013
3556
Suma'ah
ISTRI
01/07/1946
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 370 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,504 0001604333891 1901042308030003
3556
Agus riyansyah
ANAK
23/08/2003
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,505 0001604333902 1901041908080002
3556
Aldiansyah
ANAK
19/08/2008
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,506 0001604333913 1901040107410009
3567
Badrin
PESERTA
01/07/1941
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,507 0001604333924 1901044107480022
3567
Umi kalsum
ISTRI
01/07/1948
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,508 0001604333935 1901044108800002
3567
Hobsah
ANAK
01/08/1980
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,509 0001604333946 1901044107720077
3580
Asima
PESERTA
01/07/1972
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,510 0001604333957 1901042607090001
3580
Firmansyah
ANAK
26/07/2009
PETALING
01/02/2015
AKTIF
19,225
24/01/2015
8,511 0001604333968 1901084611600001
3584
Yati
PESERTA
06/11/1960
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
8,512 0001604333979 1901082609770001
3584
Marwan
ANAK
26/09/1977
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
8,513 0001604333981 1901080206780001
3584
Irul
ANAK
09/02/1978
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
8,514 0001604333992 1901081201880003
3584
Yusa
ANAK
12/01/1988
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
8,515 0001604334003 1901084107970013
3584
Susila
ANAK
01/07/1997
PUDING BESAR
01/02/2015
AKTIF
19,225
24/01/2015
8,516 0001604334014 1901050804720001
3590
SYAFERI
PESERTA
08/04/1972
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,517 0001604334025 1901054404800002
3590
SITI HODIJAH
ISTRI
04/04/1980
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,518 0001604334036 1901055205990002
3590
YOLLA MEILANDA
ANAK
12/05/1999
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,519 0001604334047 1901056107020005
3590
ANASTASYA VIRGIAN
ANAK
21/07/2002
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,520 0001604334058 1901052004130001
3590
DELZO BAGASKARA
ANAK
20/04/2013
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,521 0001604334069 1901052101820003
3597
Darwis
PESERTA
21/01/1982
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,522 0001604334071 1901055201800004
3597
Misnawati
ISTRI
12/01/1980
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,523 0001604334082 1901054104030001
3597
Resti Puji Lestari
ANAK
01/04/2003
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,524 0001604334093 1901056110090000
3597
Lya Rahmawati
ANAK
21/10/2009
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,525 0001604334104 1901055708760003
3602
Samiyem
PESERTA
17/08/1976
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,526 0001604334115 1901054602900001
3602
Susi Susanti
ANAK
06/02/1990
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 371 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,527 0001604334126 1901052611930001
3602
Sutrisno
ANAK
26/11/1993
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,528 0001604334137 1901050802800003
3602
Imam Suprayitno
ANAK
08/02/1980
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,529 0001604334148 1901050503740001
3607
Suparto
PESERTA
05/03/1974
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,530 0001604334159 1901055801880002
3607
Jubaidah
ISTRI
18/01/1988
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,531 0001604334161 1901050806090001
3607
Rendy Mailiando
ANAK
08/06/2009
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,532 0001604334172 1901055111830001
3611
Herlina
PESERTA
11/11/1983
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,533 0001604334183 1901051909030005
3611
Gilang Sevalvan Saputra
ISTRI
19/09/2003
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,534 0001604334194 1901050302640018
3613
Suhada
PESERTA
03/02/1964
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,535 0001604334205 1901055910740011
3613
Mariani
ISTRI
19/10/1974
PEMALI
01/02/2015
AKTIF
19,225
24/01/2015
8,536 0001604334216 1901031306580001
3620
Syaiful Baih
PESERTA
13/06/1958
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
8,537 0001604334227 1901034804500004
3620
Salmah
ISTRI
08/04/1960
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
8,538 0001604334238 1901031608940005
3620
Tipe Sultan
ANAK
16/08/1994
BATURUSA
01/02/2015
AKTIF
19,225
24/01/2015
8,539 0001604334249 1901011710110001
3634
Holiviandi Kristian
PESERTA
17/10/2011
KENANGA
01/02/2015
AKTIF
19,225
24/01/2015
8,540 0001604334273 1901015607350001
3646
Maria
PESERTA
16/07/1935
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
8,541 0001604334284 1901012306710002
3646
Burhan
SUAMI
23/06/1971
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
8,542 0001604334295 1901014306990001
3646
Agnes. Sk
ANAK
03/06/1999
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
8,543 0001604334306 1901012605090022
3659
Suhardi
PESERTA
01/01/1961
SUNGAILIAT
01/02/2015
AKTIF
19,225
24/01/2015
8,544 0001604334317 1901011210820011
3667
Oklianto
PESERTA
10/12/1982
SINAR BARU
01/02/2015
AKTIF
19,225
24/01/2015
8,545 0001604334328 1901010110880003
3667
Wulansari
ISTRI
21/10/1988
SINAR BARU
01/02/2015
AKTIF
19,225
24/01/2015
8,546 0001604334339 1901016506070002
3667
Faliza Khasanah
ANAK
25/06/2007
SINAR BARU
01/02/2015
AKTIF
19,225
24/01/2015
8,547 0001604334341 1901013008820008
3671
Adi Wahyu
PESERTA
30/08/1982
SINAR BARU
01/02/2015
AKTIF
19,225
24/01/2015
8,548 0001604334352 1901016509850015
3671
Susilawati
ISTRI
25/09/1985
SINAR BARU
01/02/2015
AKTIF
19,225
24/01/2015
8,549 0001604334363 1901015501050008
3671
Friska Aulia
ANAK
25/01/2005
SINAR BARU
01/02/2015
AKTIF
19,225
24/01/2015
12/2/15 3:16 PM
Page 372 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,550 0001604334374 1901015908130004
3671
Avvigia Hafiza Khollia
ANAK
19/08/2013
SINAR BARU
01/02/2015
AKTIF
19,225
24/01/2015
8,551 0001604334385 1901014107550007
3678
Rami
PESERTA
01/07/1955
SINAR BARU
01/02/2015
AKTIF
19,225
24/01/2015
8,552 0001604334396 1901016605920001
3678
Riyanti
ISTRI
26/05/1992
SINAR BARU
01/02/2015
AKTIF
19,225
24/01/2015
8,553 0001604334407 1901011609000003
3681
Darwin
PESERTA
16/10/1990
SINAR BARU
01/02/2015
AKTIF
19,225
24/01/2015
8,554 0001604334418 1901015210370002
3682
Rohani
PESERTA
12/10/1937
SINAR BARU
01/02/2015
AKTIF
19,225
24/01/2015
8,555 0001604334429 1901016709710005
3682
Rowati
ISTRI
27/09/1971
SINAR BARU
01/02/2015
AKTIF
19,225
24/01/2015
8,556 0001604334431 1901010807750005
3685
Akhmad Rizal
PESERTA
08/07/1975
SINAR BARU
01/02/2015
AKTIF
19,225
24/01/2015
8,557 0001604334442 1901015108770003
3685
Sari Junaina
ISTRI
11/08/1977
SINAR BARU
01/02/2015
AKTIF
19,225
24/01/2015
8,558 0001604334453 1901011009970005
3685
Rizki Darmawan
ANAK
10/09/1997
SINAR BARU
01/02/2015
AKTIF
19,225
24/01/2015
8,559 0001604334464 1901015102030002
3685
Rere Wulan Pratiwi
ANAK
11/02/2003
SINAR BARU
01/02/2015
AKTIF
19,225
24/01/2015
8,560 0001604334475 1901012205100003
3685
Nazar Permana
ANAK
22/05/2010
SINAR BARU
01/02/2015
AKTIF
19,225
24/01/2015
8,561 0001613907099 1901044712470001
JAHRIN
PESERTA
07/12/1947
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,562 0001613907101 1901040701830007
IS
ISTRI
07/01/1983
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,563 0001613907112 1901042505090001
MINYAK TANYE
PESERTA
12/12/1941
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,564 0001613907123 1901049107530060
SURYANI
PESERTA
01/07/1953
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,565 0001613907134 1901046404920002
ROSITA
ANAK
24/04/1992
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,566 0001613907145 1901046712630003
MAJUM
PESERTA
27/12/1963
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,567 0001613907156 1901046705970001
PINDAWATI
ANAK
27/05/1997
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,568 0001613907167 1901044107600120
SOLMAH
TAMBAHAN
01/07/1960
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,569 0001613907189 1901040112460002
10
SALIK
PESERTA
01/12/1946
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,570 0001613907191 1901045408510002
11
AISAH
PESERTA
14/08/1957
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,571 0001613907202 1901047112230001
12
MENAH
PESERTA
31/12/1923
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,572 0001613907213 1901045201400001
13
ERNA HAYATI
PESERTA
12/01/1940
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 373 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,573 0001613907224 1901047108940002
13
FITRI ANGGRAINI
ANAK
31/08/1994
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,574 0001613907235 1901040512970001
13
ILHAM FEBRIYANSYAH
ANAK
05/12/1997
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,575 0001613907246 1901045005470001
16
MI
PESERTA
10/05/1947
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,576 0001613907257 1901041905380001
17
KASIRAN
PESERTA
19/05/1938
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,577 0001613907268 1901040107470069
18
SELAHA
PESERTA
01/07/1947
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,578 0001613907279 1901040403720002
18
SELAHUT
ANAK
04/03/1972
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,579 0001613907281 1901044104810002
18
SAUDA
ANAK
01/04/1981
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,580 0001613907292 1901044202840001
18
LENI
ANAK
02/02/1984
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,581 0001613907303 1901041701870007
18
SULKODRI
ANAK
17/01/1987
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,582 0001613907314 1901040303890002
18
ARIFIN
ANAK
03/03/1989
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,583 0001613907325 1901040107570002
24
TAMIS
PESERTA
01/07/1957
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,584 0001613907336 1901044107700107
25
MARYATI
PESERTA
01/07/1970
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,585 0001613907347 1901040605930001
25
HARIKO PRATAMA
ANAK
06/05/1993
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,586 0001613907358 1901042510940002
25
HARYADI PRAMANA
ANAK
25/01/1994
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,587 0001613907369 1901047009960005
25
SEPTIA WULANDARI
ANAK
30/09/1996
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,588 0001613907371 1901046411080002
25
PUJI SUKMA RANY
ANAK
24/11/2008
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,589 0001613907382 1901040701510004
30
DOL IBRAHIM
PESERTA
07/01/1946
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,590 0001613907393 1901040701870008
30
ISKANDAR
ANAK
07/01/1986
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,591 0001613907404 1901047112590004
32
SAINUR
PESERTA
31/12/1959
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,592 0001613907415 1901040110720005
32
HARYANTO
ANAK
01/10/1972
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,593 0001613907426 1901044311440001
34
SENAK URUT
PESERTA
03/11/1944
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,594 0001613907437 1901046011600002
35
JAIPAH
PESERTA
20/11/1980
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,595 0001613907448 1901044112360002
36
ROBAYAH
PESERTA
01/12/1936
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 374 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,596 0001613907459 1901044407600001
36
ROMLAH
ANAK
04/07/1960
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,597 0001613907461 1901046302650001
38
ZAINAB
PESERTA
23/02/1965
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,598 0001613907472 1901041901890004
38
AYU WANDERA
ANAK
19/08/1990
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,599 0001613907483 1901041011920004
38
SAFERIYUS
ANAK
19/08/1992
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,600 0001613907494 1901040705970002
38
ISAYADI
ANAK
10/11/1997
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,601 0001613907505 1901045102030002
38
PUTRI DINI HARI
ANAK
11/02/2003
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,602 0001613907516 1901040408840001
43
SABUDI ARMANDA
PESERTA
04/08/1984
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,603 0001613907527 1901044605720003
44
AYUMA
PESERTA
06/05/1972
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,604 0001613907538 1901046404010001
44
LALA
ANAK
24/04/2001
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,605 0001613907549 1901044107440027
46
SATIYEM
PESERTA
01/07/1944
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,606 0001613907551 1901045106470002
47
AJAH
PESERTA
11/06/1947
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,607 0001613907562 1901045104570002
48
ROSNAH
PESERTA
11/04/1957
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,608 0001613907573 1901040307800003
48
RUSTAM
ANAK
03/07/1980
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,609 0001613907584 1901045711930002
48
NOVIAH
ANAK
17/11/1993
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,610 0001613907595 1901042505970002
48
RUSLAN
ANAK
25/05/1997
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,611 0001613907606 1901040405890001
52
OMA
PESERTA
04/05/1989
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,612 0001613907617 1901044111550001
52
AMUK
TAMBAHAN
01/11/1955
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,613 0001613907628 1901045203610002
54
SOLYAH
PESERTA
12/03/1961
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,614 0001613907639 1901041703870001
54
SUDARMONO
ANAK
17/03/1987
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,615 0001613907641 1901045208920001
54
SOPIAH
ANAK
12/08/1992
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,616 0001613907652 1901046908940001
54
TUTTI
ANAK
29/08/1994
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,617 0001613907663 1901046308980004
54
JULAIHA
ANAK
23/08/1998
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,618 0001613907674 1901046306010002
54
RATNA
ANAK
23/06/2001
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 375 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,619 0001613907685 1901045008040001
54
SOTANIA
ANAK
10/08/2004
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,620 0001613907696 1901041809060001
54
SOIWAN
ANAK
18/09/2006
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,621 0001613907707 1901044701500007
62
NOR AINI
PESERTA
07/01/1950
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,622 0001613907718 1901044107510050
63
TAYANI
PESERTA
01/07/1951
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,623 0001613907729 1901044207920002
63
FATMALA DEWI
ANAK
02/07/1992
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,624 0001613907731 1901044905560001
65
HAPSA
PESERTA
09/05/1956
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,625 0001613907742 1901041509880001
66
SARUNI
PESERTA
15/09/1988
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,626 0001613907753 1901045402650001
66
JAMIL
ISTRI
14/02/1955
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,627 0001613907764 1901045802480001
68
NURHAYATI
PESERTA
18/02/1948
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,628 0001613907775 1901041209880005
68
TOVAN IBRRANI
ANAK
12/09/1988
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,629 0001613907786 1901045204530001
70
PAUYAH
PESERTA
12/04/1953
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,630 0001613907797 1901045206890007
70
SULASMI
ANAK
12/06/1989
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,631 0001613907808 1901044708850001
72
SULASTRI
PESERTA
07/08/1985
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,632 0001613907819 1901040707020008
72
YUDA KUSNANDAR
ANAK
07/07/2002
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,633 0001613907821 1901042503090002
72
AKBAR KURNIAWAN
ANAK
25/03/2009
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,634 0001613907832 1901044107430001
75
RAHYE
PESERTA
01/07/1943
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,635 0001613907843 1901047112350002
76
ROMIAH
PESERTA
31/12/1935
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,636 0001613907854 1901045607700002
77
SURYAH
PESERTA
16/07/1970
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,637 0001613907865 1901041101970001
77
MITRA SUSANTO
ANAK
07/12/1994
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,638 0001613907876 1901040302060003
77
FERDIANSYAH
ANAK
03/02/2006
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,639 0001613907887 1901044605620002
80
MARDIAH
PESERTA
06/05/1962
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,640 0001613907898 1901044501890002
80
MURNIATI
ANAK
05/01/1989
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,641 0001613907909 1901042509940003
80
TRIS SAPUTRA
ANAK
25/09/1994
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 376 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,642 0001613907911 1901044109980002
80
TIRA SANTIA
ANAK
01/09/1998
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,643 0001613907922 1901044511600003
84
SOPRAH
PESERTA
05/11/1960
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,644 0001613907933 1901046402450001
85
AZIMAH
PESERTA
01/10/1945
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,645 0001613907944 1901040309920001
85
RISKAN ARZONA
ANAK
03/09/1992
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,646 0001613907955 1901044604950002
85
RISKA ARSITA
ANAK
06/04/1995
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,647 0001613907966 1901044203470001
88
MINAH
PESERTA
02/03/1947
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,648 0001613907977 1901040604830002
88
TONO
ANAK
06/04/1983
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,649 0001613907988 1901046205640001
90
Jamilah
PESERTA
22/05/1964
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,650 0001613907999 1901046407860001
90
Ria rahmawati
ANAK
24/07/1986
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,651 0001613908001 1901041208000003
90
David
ANAK
08/12/2000
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,652 0001613908012 1901040107580063
93
Mursit
PESERTA
01/07/1958
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,653 0001613908023 1901040107890056
93
kahpi
ANAK
01/07/1989
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,654 0001613908034 1901040107900039
93
Musa
ANAK
01/07/1990
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,655 0001613908045 1901044107940058
93
Pasri
ANAK
01/07/1994
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,656 0001613908056 1901040107990075
93
Toni
ANAK
01/07/1999
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,657 0001613908067 1901044107570042
98
Saro
PESERTA
01/07/1957
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,658 0001613908078 1901040609820001
98
Ismail
ANAK
01/07/1982
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,659 0001613908089 1901046006930001
98
Homsah
ANAK
10/06/1993
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,660 0001613908091 1901044107370027
101
Romlah
PESERTA
01/07/1937
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,661 0001613908102 1901045102540001
102
Raudah
PESERTA
11/02/1954
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,662 0001613908113 1901044107850108
102
Tura
ANAK
01/07/1985
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,663 0001613908124 1901040810010002
102
muhammad hasbi
ANAK
08/10/2001
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,664 0001613908135 1901044806030004
102
Nuraini
ANAK
08/06/2003
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 377 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,665 0001613908146 1901045208440001
106
Zaroh
PESERTA
12/08/1944
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,666 0001613908157 1901044602620001
107
Robi'ah
PESERTA
06/02/1962
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,667 0001613908168 1901040807860002
107
Satria
ANAK
08/07/1986
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,668 0001613908179 1901041210980002
107
M. dasril arian
ANAK
12/10/1998
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,669 0001613908181 1901041008730004
110
Romli
PESERTA
10/08/1973
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,670 0001613908192 1901042102000002
110
Perdi bahtiar
ANAK
21/02/2000
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,671 0001613908203 1901045402020002
110
Parida asmara
ANAK
14/02/2002
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,672 0001613908214 1901045801050003
110
Halimatus sakdiah
ANAK
18/01/2005
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,673 0001613908225 1901040107460026
114
A. Bizar
PESERTA
01/07/1946
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,674 0001613908236 1901040309720001
115
Muhammad efendi
PESERTA
03/09/1972
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,675 0001613908247 1901041410940001
115
Jamiun
ANAK
14/10/1994
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,676 0001613908258 1901044403990005
115
Siti maryam
ANAK
04/03/1999
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,677 0001613908269 1901042404020002
115
Abdullah
ANAK
24/04/2002
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,678 0001613908271 1901040107050063
115
Arjab
ANAK
01/07/2005
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,679 0001613908282 1901040609080001
115
Sapriansyah
ANAK
06/09/2008
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,680 0001613908293 1901040107500072
121
Kahok
PESERTA
01/07/1950
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,681 0001613908304 1901044811520001
122
Saripah
PESERTA
08/11/1952
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,682 0001613908315 1901044903520001
123
Satimah
PESERTA
09/03/1952
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,683 0001613908326 1901045407480002
124
Jarmi
PESERTA
14/07/1948
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,684 0001613908337 1901046104950002
124
Nurul hidayah
ANAK
21/04/1995
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,685 0001613908348 1901044709590001
126
Sakdiah
PESERTA
07/09/1959
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,686 0001613908359 1901045907920001
126
Aswa
ANAK
19/07/1992
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,687 0001613908361 1901045308950001
126
Sarkinah
ANAK
28/08/1995
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 378 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,688 0001613908372 1901044107600111
129
Subai
PESERTA
01/07/1960
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,689 0001613908383 1901044908590001
130
Rodiah
PESERTA
09/08/1959
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,690 0001613908394 1901044107600033
131
Padiah
PESERTA
01/07/1960
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,691 0001613908405 1901044107650114
132
Rosmini
PESERTA
01/07/1965
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,692 0001613908416 1901040107900115
132
Anmadi
ANAK
01/07/1990
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,693 0001613908427 1901046803000001
132
Siti anisa
ANAK
28/03/2000
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,694 0001613908438 1901044302040002
132
Milita srikah
ANAK
03/02/2004
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,695 0001613908449 1901044607570001
136
Rosmi
PESERTA
06/07/1957
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,696 0001613908451 1901040305950002
136
Mahmud apendi
ANAK
03/05/1995
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,697 0001613908462 1901040107470029
138
Zalimah
PESERTA
01/07/1947
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,698 0001613908473 1901040107820061
138
Iskandar
ANAK
01/07/1982
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,699 0001613908484 1901040706680004
140
Sulaiman
PESERTA
07/06/1968
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,700 0001613908495 1901044509000006
140
Kiswatun amanah
ANAK
05/09/2000
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,701 0001613908506 1901046710030002
140
Musallimah
ANAK
10/12/2003
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,702 0001613908517 1901045111060005
140
Patonah
ANAK
11/11/2006
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,703 0001613908528 1901040809100002
140
Abdul majid
ANAK
08/09/2010
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,704 0001613908539 1901041105930001
145
Sudirman
PESERTA
11/05/1993
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,705 0001613908541 1901044107530068
146
Horiah
PESERTA
01/07/1953
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,706 0001613908552 1901044904300001
147
Saunah
PESERTA
09/04/1930
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,707 0001613908563 1901045603380001
148
Murni
PESERTA
06/03/1938
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,708 0001613908574 1901044910620002
149
Nursidin
PESERTA
08/04/1963
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,709 0001613908585 1901040605840001
149
Wahyudi
ANAK
25/04/1992
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,710 0001613908596 1901040501680002
149
Reni febrianti
ANAK
01/07/1995
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 379 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,711 0001613908607 1901040312700002
149
Nurul hikmah
ANAK
15/04/1998
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,712 0001613908618 1901044402400001
149
Sopiana
ANAK
01/07/2001
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,713 0001613908629 1901040706810003
154
SUPARJO
PESERTA
07/06/1981
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,714 0001613908631 1901045101620002
155
SOPIAH
PESERTA
11/01/1962
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,715 0001613908642 1901041707900005
155
AHMAD SAPUTRA
ANAK
17/07/1990
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,716 0001613908653 1901044204960004
155
FITRIANI
ANAK
02/04/1996
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,717 0001613908664 1901046610320001
158
SURNA
PESERTA
10/12/1932
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,718 0001613908675 1901041011690015
158
DAMHER
ANAK
10/11/1969
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,719 0001613908686 1901046104660002
160
JAMI'AH
PESERTA
21/04/1966
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,720 0001613908697 1901045003920003
160
FEBRIYANDA ROMAYANTI
ANAK
10/03/1992
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,721 0001613908708 1901040707970001
160
FIKRI MULYA SATIAWAN
ANAK
07/07/1997
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,722 0001613908719 1901045001000004
160
FITRI INTAN PRATIWI
ANAK
10/01/2000
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,723 0001613908721 1901041507030007
160
FERI YOLANDIKA WILANDA
ANAK
15/07/2003
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,724 0001613908732 1901042112100002
160
FAHREZA ADITYA SYAKI
ANAK
21/12/2010
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,725 0001613908743 1901046105740001
166
IDA ROYATI
PESERTA
21/05/1974
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,726 0001613908754 1901045410960001
166
RATNA SARI DEWI
ANAK
14/10/1996
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,727 0001613908765 1901042209980007
166
ZULFIKAR
ANAK
22/09/1998
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,728 0001613908776 1901042204020003
166
MADIAN HIBI
ANAK
22/04/2002
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,729 0001613908787 1901042606040002
166
A.PATONI
ANAK
26/06/2004
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,730 0001613908798 1901044104090004
166
REISYA APRILIA
ANAK
01/04/2009
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,731 0001613908809 1901045204640001
172
KURZIAH
PESERTA
12/04/1964
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,732 0001613908811 1901040806900002
172
MUHAMMAD ZAKI
ANAK
08/06/1990
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,733 0001613908822 1901046604960003
172
SITI ARPAH
ANAK
26/04/1996
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 380 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,734 0001613908833 1901044107620124
175
BAHRIAH
PESERTA
01/07/1962
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,735 0001613908844 1901040804970002
175
ABDUL YAZID
ANAK
08/04/1997
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,736 0001613908855 1901046509000002
175
NAZILAH
ANAK
25/09/2000
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,737 0001613908866 1901042303030003
175
PAHROROZI
ANAK
23/03/2003
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,738 0001613908877 1901040107530069
179
MARSUNAH
PESERTA
01/07/1953
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,739 0001613908888 1901040903940001
179
SUFRIYADI
ANAK
09/03/1994
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,740 0001613908899 1901041011000002
179
RIZKI ROHIM
ANAK
10/11/2000
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,741 0001613908901 1901041103820001
179
SAMSUL BAHRI
ANAK
11/03/1982
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,742 0001613908912 1901040302860004
179
ISWADI
ANAK
03/02/1986
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,743 0001613908923 1901044506900001
179
EVI SUSANTI
ANAK
05/06/1990
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,744 0001613908934 1901044510920002
179
EVA SURYA DEWI
ANAK
05/10/1992
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,745 0001613908945 1901044809580002
186
SUN WATI
PESERTA
08/09/1956
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,746 0001613908956 1901042910850001
186
RUDI KARMIDI
ANAK
29/10/1985
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,747 0001613908967 1901041607880003
186
QORI KURNIADI
ANAK
16/07/1988
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,748 0001613908978 1901044303920002
186
LISA MARLINA
ANAK
03/03/1992
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,749 0001613908989 1901044709950003
186
RISKA DEWI
ANAK
07/09/1995
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,750 0001613908991 1901044310970006
186
MIRANTI
ANAK
03/10/1997
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,751 0001613909002 1901046007000003
186
RISNAWATI
ANAK
20/07/2000
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,752 0001613909013 1901045407440001
193
SITI
PESERTA
14/07/1944
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,753 0001613909024 1901045504430002
194
ROPIAH
PESERTA
15/04/1943
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,754 0001613909035 1901045503710001
195
NURHAYATI
PESERTA
21/03/1971
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,755 0001613909046 1901044107470057
196
MARYAM
PESERTA
01/07/1947
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,756 0001613909057 1901044201590001
197
JARIAH
PESERTA
02/01/1959
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 381 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,757 0001613909068 1901044107400029
198
JUMIAH
PESERTA
01/07/1940
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,758 0001613909079 1901045004670003
199
ZAINAH
PESERTA
10/04/1967
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,759 0001613909081 1901044101590001
200
ZUBAIDAH
PESERTA
01/01/1959
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,760 0001613909092 1901044107450038
201
ZAINAB
PESERTA
01/07/1945
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,761 0001613909103 1901044107390002
202
SARIYAH
PESERTA
01/07/1939
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,762 0001613909114 1901044710530001
203
ISMIWATI
PESERTA
01/07/1954
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,763 0001613909125 1901044107620010
204
NURSIDA
PESERTA
01/07/1962
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,764 0001613909136 1901040107520048
205
SARUDIN
PESERTA
01/07/1952
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,765 0001613909147 1901046302510001
206
SARAH
PESERTA
23/02/1951
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,766 0001613909169 1901045302400009
208
MAIMUNAH
PESERTA
13/02/1940
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,767 0001613909171 1901044107750084
209
HOPSAH
PESERTA
01/07/1975
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,768 0001613909182 1901040107580001
210
SURYA DARMASI
PESERTA
01/07/1958
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,769 0001613909193 1901040911650001
211
HURMEN
PESERTA
09/11/1965
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,770 0001613909204 1901042209710001
212
M.HUDAWI
PESERTA
22/09/1971
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,771 0001613909215 1901044107540046
213
ASMAH
PESERTA
01/07/1954
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,772 0001613909226 1901040107570085
214
HASAN
PESERTA
01/07/1957
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,773 0001613909237 1901040107670100
215
AKMAD PUTIK
PESERTA
01/07/1967
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,774 0001613909248 1901040303460001
216
APENDI
PESERTA
03/03/1946
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,775 0001613909259 1901040107520053
217
HOIRI
PESERTA
01/07/1952
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,776 0001613909261 1901040407520003
218
MUCHTAR
PESERTA
04/07/1952
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,777 0001613909272 1901040107590090
219
MUHAMMAD
PESERTA
01/07/1959
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,778 0001613909283 1901041008780002
220
MULYADI
PESERTA
10/06/1978
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,779 0001613909294 1901040806590001
221
M.YUSUF
PESERTA
08/06/1959
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 382 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,780 0001613909305 1901044811720002
222
SITI ROGAYAH
PESERTA
29/06/1967
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,781 0001613909316 1901044107650017
223
SUMIATI
PESERTA
01/07/1965
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,782 0001613909327 1901041011510003
224
HAMDAN
PESERTA
10/11/1951
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,783 0001613909338 1901044107440018
225
ROSNAH
PESERTA
01/07/1944
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,784 0001613909349 1901040609610002
226
YUSMAN
PESERTA
08/09/1961
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,785 0001613909351 1901044010750037
227
YUHANIS
PESERTA
01/07/1950
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,786 0001613909362 1901044107580091
228
KOMARIYAH
PESERTA
01/07/1958
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,787 0001613909373 1901046610557002
229
YANA
PESERTA
21/05/1970
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,788 0001613909384 1901044107380004
230
HOPSAH
PESERTA
01/07/1938
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,789 0001613909395 1901042401670001
231
SUHAIRI
PESERTA
24/01/1967
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,790 0001613909406 1901044107480007
232
SITI HAWA
PESERTA
01/07/1948
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,791 0001613909417 1901044107570086
233
PAUZIAH
PESERTA
01/07/1957
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,792 0001613909428 1901040107470011
234
ABDUL WAHAB
PESERTA
01/07/1947
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,793 0001613909439 1901046503940001
235
SITI ALFIATUL SYAKDIAH
PESERTA
25/03/1994
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,794 0001613909441 1901044107400044
236
Roji'ah
PESERTA
01/07/1940
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,795 0001613909452 1901044902940004
236
Diana
ANAK
09/02/1994
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,796 0001613909463 1901044107520079
238
Siti sarah
PESERTA
01/07/1952
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,797 0001613909474 1901040107360006
239
Tabaroni
PESERTA
01/07/1936
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,798 0001613909485 1901042004760002
239
Gunawan
ANAK
20/04/1976
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,799 0001613909496 1901044107570075
241
Asnah
PESERTA
01/07/1957
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,800 0001613909507 1901042011010002
241
Toni
ANAK
20/11/2001
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,801 0001613909518 1901044107360011
243
Hotimah
PESERTA
01/07/1936
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,802 0001613909529 1901045302580001
244
Rosmi
PESERTA
13/02/1958
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 383 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,803 0001613909531 1901044107490023
245
Hazina
PESERTA
01/07/1949
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,804 0001613909542 1901044107310019
246
Hanah
PESERTA
01/07/1931
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,805 0001613909553 1901044204650001
247
Suryah
PESERTA
01/07/1935
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,806 0001613909564 1901041605930003
247
Munzal
ANAK
01/07/1938
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,807 0001613909575 1901044107710058
249
Zarwani
PESERTA
01/07/1971
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,808 0001613909586 1901041305070003
249
Hudarni rani
ANAK
13/05/2007
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,809 0001613909597 1901045501620001
251
Rosnah
PESERTA
15/01/1962
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,810 0001613909608 1901042903980001
251
Zawawi
ANAK
29/03/1988
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,811 0001613909619 1901041304800002
251
Rozali
ANAK
13/04/1980
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,812 0001613909621 1901045302680001
254
Hotiah
PESERTA
13/02/1968
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,813 0001613909632 1901041802820004
254
Irwanto
ANAK
18/02/1982
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,814 0001613909643 1901046607980001
254
Sumami
ANAK
26/07/1998
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,815 0001613909654 1901044107650124
257
Aminah
PESERTA
01/07/1965
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,816 0001613909665 1901041510890003
257
Masuri
ANAK
15/10/1989
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,817 0001613909676 1901040107540041
259
Pai
PESERTA
01/07/1954
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,818 0001613909687 1901040109940001
259
Pilihan
ANAK
01/09/1994
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,819 0001613909698 1901045202980003
259
Suciati
ANAK
12/02/1998
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,820 0001613909709 1901044107370047
262
Sohiba
PESERTA
01/07/1937
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,821 0001613909711 1901044809750003
263
Gotiana
PESERTA
05/08/1975
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,822 0001613909722 1901045212000002
263
Gini holisah
ANAK
12/12/2000
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,823 0001613909733 1901040712090001
263
Gani satrio
ANAK
07/12/2009
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,824 0001613909744 1901041510120001
263
Hoiri akbar
ANAK
15/10/2012
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,825 0001613909755 1901040107860105
267
Mulyadi
PESERTA
01/07/1986
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 384 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,826 0001613909766 1901045105100001
267
Rini marini
ANAK
11/05/2010
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,827 0001613909777 1901044107510045
269
Sena'ah
PESERTA
01/07/1951
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,828 0001613909788 1901041603780002
269
Simin
ANAK
16/03/1978
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,829 0001613909799 1901040712810003
269
Sarudin
ANAK
07/12/1981
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,830 0001613909801 1901040807820006
272
Sahril
PESERTA
08/07/1982
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,831 0001613909812 1901074107640015
273
Sunah
PESERTA
01/07/1964
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,832 0001613909823 1901044107480053
274
Alma
PESERTA
01/07/1948
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,833 0001886521691 1901044107850093
274
Sudira
ANAK
01/07/1985
PETALING
01/05/2015
AKTIF
19,225
16/09/2015
8,834 0001613909834 1901044107410021
275
Darnawati
PESERTA
01/07/1961
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,835 0001613909845 1901040805930004
275
Jumadi
ANAK
08/05/1993
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,836 0001613909856 1901042209950001
275
Junani. B
ANAK
22/09/1995
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,837 0001613909867 1901040107660033
278
Paizal
PESERTA
01/07/1966
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,838 0001613909878 1901042103920001
278
Wandi
ANAK
21/03/1992
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,839 0001613909889 1901045506950002
278
Suryanti
ANAK
15/06/1995
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,840 0001613909891 1901046412050004
278
Dian linda
ANAK
24/12/2005
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,841 0001613909902 1901040802740031
282
Hanafi
PESERTA
08/02/1974
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,842 0001613909913 1901042012950001
282
Nur hapipi
ANAK
20/12/1995
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,843 0001613909924 1901041312980005
282
Randi
ANAK
13/12/1989
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,844 0001613909935 1901040712010008
282
Robu'in
ANAK
07/12/2001
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,845 0001613909946 1901041908070003
282
Agustin AL
ANAK
19/08/2007
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,846 0001886524233 1901044107850090
282
SUDIRA
ANAK
01/07/1985
PETALING
01/05/2015
AKTIF
19,225
16/09/2015
8,847 0001613909957 1901044107480023
287
Niah
PESERTA
01/07/1948
PETALING
01/05/2015
AKTIF
19,225
22/04/2015
8,848 0001613909968 1901075306810001
288
Yunarti
PESERTA
13/06/1981
RIAU SILIP
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 385 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,849 0001613909979 1901075404000001
288
Yuri Afriyanti
ANAK
04/04/2000
RIAU SILIP
01/05/2015
AKTIF
19,225
22/04/2015
8,850 0001613909981 1901074202080001
288
Bunga Febiola
ANAK
02/02/2008
RIAU SILIP
01/05/2015
AKTIF
19,225
22/04/2015
8,851 0001613909992 1901072308650001
291
Sin Hian
PESERTA
23/08/1965
RIAU SILIP
01/05/2015
AKTIF
19,225
22/04/2015
8,852 0001613910003 1901036211670001
292
FATIMAH
PESERTA
22/11/1967
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,853 0001613910014 1901055508530003
293
MISYAH TUKIBAN
PESERTA
15/08/1953
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,854 0001613910025 1901034202430002
294
ASIAH
PESERTA
02/02/1943
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,855 0001613910036 1901034107590017
295
SUBAIDAH
PESERTA
01/07/1959
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,856 0001613910047 1901035804970002
295
ROHAYA
ANAK
18/04/1997
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,857 0001613910058 1901034401500001
297
SULASTRI
PESERTA
04/01/1950
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,858 0001613910069 1901031310990001
297
SURYADI
ANAK
13/10/1999
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,859 0001613910071 1901037112520002
299
ROPIAH
PESERTA
31/12/1958
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,860 0001613910082 1901036808950001
299
SUMINAH
ANAK
28/08/1995
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,861 0001613910093 1901031204920002
299
ZUL AMRI
ANAK
12/04/1992
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,862 0001613910104 1901034107240003
302
JAMILUN
PESERTA
01/07/1924
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,863 0001613910115 1901034107630024
302
DAINA
ANAK
01/07/1963
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,864 0001613910126 1901034503510003
304
SUNLAN
PESERTA
05/03/1951
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,865 0001613910137 1901034107410004
305
HALIMAH AMAN
PESERTA
01/07/1941
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,866 0001613910148 1901034107430007
306
ROMLAH
PESERTA
01/07/1943
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,867 0001613910159 1901035611750001
307
ZUBAIDAH
PESERTA
16/09/1975
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,868 0001613910161 1901035211110001
307
SYAZA LAILANI
ANAK
12/11/2011
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,869 0001613910172 1901031409020001
307
FAHKRIZA HUSSAINI
ANAK
14/09/2002
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,870 0001613910183 1901034505600001
310
SAMI
PESERTA
05/05/1960
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,871 0001613910194 1901036607490001
311
BONG JUN MI
PESERTA
26/07/1949
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 386 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,872 0001613910205 1901030701380011
312
SUIB KARTO
PESERTA
07/01/1938
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,873 0001613910216 1901034107550029
313
NURHAYATI
PESERTA
01/07/1955
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,874 0001613910227 1901034107290009
314
ISAH
PESERTA
01/07/1929
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,875 0001613910238 1901034701500004
315
SITI AMINAH
PESERTA
07/01/1950
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,876 0001613910249 1901034107330006
316
TJONG KIM SOEI
PESERTA
20/03/1933
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,877 0001613910251 1901036611560001
317
NURLELA
PESERTA
26/11/1956
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,878 0001613910262 1901034701600007
318
BAUYAH
PESERTA
07/01/1962
01/05/2015
AKTIF
19,225
22/04/2015
8,879 0001613910273 1901030701560020
319
ROSINA
PESERTA
07/01/1956
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,880 0001613910284 1901031810330001
320
CHIN A HOI
PESERTA
18/10/1933
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,881 0001613910295 1901030107550018
321
SAPARUDIN
PESERTA
01/07/1955
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,882 0001613910306 1901030107380010
322
ABON
PESERTA
01/07/1938
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,883 0001613910317 1901034703880003
323
MARTINI
PESERTA
07/03/1988
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,884 0001613910328 1901031607090001
323
ARJUNA MANDALA PUTRA
ANAK
16/07/2009
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,885 0001613910339 1901034711490001
325
ROSMALA
PESERTA
11/07/1949
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,886 0001613910341 1901035806530001
326
LOT JE CANDRA
PESERTA
18/06/1953
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,887 0001613910352 1901034701430014
327
ALPIAH
PESERTA
07/01/1943
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,888 0001613910363 1901035106630001
328
ZAINUR
PESERTA
11/06/1963
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,889 0001613910374 1901034107500011
329
HOZIAH
PESERTA
01/07/1950
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,890 0001613910385 1901034701450006
330
SENAH
PESERTA
07/01/1945
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,891 0001613910396 1901034509270001
331
JELIHA
PESERTA
05/09/1927
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,892 0001613910407 1901034107420008
332
HOTIJAH
PESERTA
01/07/1942
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,893 0001613910418 1901030107340012
333
TOHA
PESERTA
01/07/1934
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,894 0001613910429 1901034107490012
334
JUMROH
PESERTA
01/07/1949
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 387 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,895 0001613910431 1901034403330001
335
HAYUNA
PESERTA
04/03/1933
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,896 0001613910442 1901034107480014
336
ROHANA
PESERTA
01/07/1948
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,897 0001613910453 1901034107450011
337
SUAI
PESERTA
01/07/1945
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,898 0001613910464 1901032404820002
337
MUHAMMAD MUSLIM
ANAK
24/04/1982
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,899 0001613910475 1901035806580001
339
ALMI
PESERTA
18/06/1958
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,900 0001613910486 1901030906520002
340
BUJANG
PESERTA
06/09/1952
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,901 0001613910497 1901036603640001
341
SABIHA
PESERTA
26/03/1964
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,902 0001613910508 1901034107600022
342
HOLIJAH
PESERTA
01/07/1960
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,903 0001613910519 1901036110810003
342
SANTI RUPIKA
ANAK
21/10/1981
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,904 0001613910521 1901034107540011
344
HATEMAH
PESERTA
01/07/1954
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,905 0001613910532 1901034112550003
345
ROZIAH RAIZ
PESERTA
12/01/1955
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,906 0001613910543 1901034901880001
345
SUARSIH
ANAK
01/09/1988
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,907 0001613910554 1901034908950003
345
YANI KUSUMAWATI
ANAK
08/09/1995
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,908 0001613910565 1901036905570001
348
LIE TJHAW KAP
PESERTA
29/05/1954
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,909 0001613910576 1901037105700002
349
SIM MIE YEN
PESERTA
31/05/1970
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,910 0001613910587 1901030701360004
350
JAMALIAH
PESERTA
01/07/1936
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,911 0001613910598 1901034107670025
351
AMLAH
PESERTA
07/01/1967
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,912 0001613910609 1901034701430009
352
FATIMAH
PESERTA
01/07/1943
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,913 0001613910611 1901034701510008
353
KHOTIJAH
PESERTA
01/07/1951
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,914 0001613910622 1901034405620001
354
AISAH
PESERTA
05/04/1962
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,915 0001613910633 1901030102930003
354
DEDI
ANAK
02/01/1993
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,916 0001613910644 1901037005970002
354
JUMAYTA
ANAK
30/05/1997
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,917 0001613910655 1901034701380010
357
RAHAYUT
PESERTA
01/07/1938
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 388 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,918 0001613910666 1901030107310006
358
NADIN
PESERTA
07/01/1931
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,919 0001613910677 1901036611770002
359
KOMSIATUN
PESERTA
26/11/1977
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,920 0001613910688 1901034710980002
359
PRAMITA SARI
ANAK
10/07/1998
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,921 0001613910699 1901034111420001
361
ARIA
PESERTA
11/01/1942
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,922 0001613910701 1901034205720002
362
ERNAWATI
PESERTA
05/02/1972
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,923 0001613910712 1901030407020002
362
PIKKI WIJAYA
ANAK
07/04/2002
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,924 0001613910723 1901034701750005
364
SINAR JUWITA
PESERTA
06/12/1954
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
8,925 0001613910734 1901016705810005
365
YANTI HARTATI
PESERTA
27/05/1981
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,926 0001613910745 1901011704730001
366
DANI
PESERTA
17/04/1973
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,927 0001613910756 1901012006930001
366
FREDY ANGGARA
ANAK
20/06/1993
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,928 0001613910767 1901012609940002
366
RAVEL
ANAK
26/09/1994
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,929 0001613910778 1901010108760001
369
YUNG YUNG
PESERTA
01/08/1976
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,930 0001613910789 1901012508690003
370
AGUS WIJAYA
PESERTA
25/08/1969
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,931 0001613910791 1901014501730002
370
FERAWATI
ISTRI
05/01/1973
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,932 0001613910802 1901014105010002
370
MEILANYANI
ANAK
01/05/2001
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,933 0001613910813 1901015205040001
370
LUSI WIJAYANTI
ANAK
12/05/2004
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,934 0001613910824 1901015807080003
370
PUTRISIA WIJAYANTI
ANAK
18/07/2008
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,935 0001613910835 1901014107530026
375
BOEN MOEK SIAN
PESERTA
04/03/1952
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,936 0001613910846 1901012111760001
376
LIM KONG SEN
PESERTA
21/11/1978
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,937 0001613910857 1901015003830001
376
FITA
ISTRI
10/03/1983
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,938 0001613910868 1901012101070002
376
JEFFRY FERNANDO
ANAK
21/01/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,939 0001613910879 1901011108110001
376
REYFAN ALVIANO JUSTINE
ANAK
11/08/2011
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,940 0001613910881 1901010505990008
380
FERNANDO
PESERTA
05/05/1999
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 389 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,941 0001613910892 1901014402030001
380
MONA MONICA
ANAK
04/02/2003
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,942 0001613910903 1901015005590005
382
MIZAR
PESERTA
29/11/1990
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,943 0001613910914 1901015510930004
382
NIKA
ISTRI
15/10/1993
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,944 0001613910925 1901010608010003
382
SINTOUN
ANAK
06/08/2001
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,945 0001613910936 1901011708880019
385
SUSANDRA
PESERTA
17/08/1988
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,946 0001613910947 1901011210950005
385
HAMSAH
ISTRI
12/10/1995
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,947 0001613910958 1901015208870001
387
ERBUNA
PESERTA
12/08/1987
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,948 0001613910969 1901011003080004
387
REGA DINATA ERLANGGA
ANAK
10/03/2008
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,949 0001613910971 1604060808820000
389
YALFANI
PESERTA
18/08/1982
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,950 0001613910982 1901012906880003
390
JUNIKA DARMAWAN
PESERTA
29/06/1988
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,951 0001613910993 1606016308900000
391
HESTI MANDASARI
PESERTA
23/08/1990
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,952 0001613911004 1606015010990005
391
SRI ASTUTI
TAMBAHAN
10/10/1999
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,953 0001613911015 1901014403970000
393
ELIYA
PESERTA
04/03/1970
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,954 0001613911026 1901010212900003
393
YOSSIE FYBRIANTO
ANAK
02/12/1990
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,955 0001613911037 1901014305960011
393
RIZKY WULAN PURNAMASARI ANAK
03/05/1996
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,956 0001613911048 1901015611050002
393
CHINDY HERMALIA PUTRI
ANAK
16/11/2005
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,957 0001613911059 1901011307070006
397
HARIRI
PESERTA
13/07/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,958 0001613911061 1901016810760005
398
KOMALA DEWI
PESERTA
28/10/1976
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,959 0001613911072 1901016806060004
399
VINA
PESERTA
26/06/2006
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,960 0001613911083 1901010206640003
400
SYAMSUDIN
PESERTA
02/06/1964
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,961 0001613911094 1901015205640002
400
FITRI DAWARSIH
ISTRI
12/05/1964
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,962 0001613911105 1901014110540005
402
SURYA MURNI
PESERTA
01/10/1954
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,963 0001613911116 1901011206240001
403
DJAMAL
PESERTA
12/05/1924
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 390 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,964 0001613911127 1901010701760005
404
KURNAIN
PESERTA
07/01/1976
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,965 0001613911138 1901012712020002
404
HIDAYATULLAH
SUAMI
27/12/1978
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,966 0001613911149 1901011801070004
404
ICHSAN AL KATIRI
ANAK
18/01/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,967 0001613911151 1901010410080008
404
AHMAD ANSORI
ANAK
04/10/2008
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,968 0001613911162 1901016508720006
408
JUMLIAH
PESERTA
25/08/1972
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,969 0001613911173 1901015401980004
408
ROSALINA
ANAK
14/01/1998
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,970 0001613911184 1901010201690004
410
JOHAN
PESERTA
02/01/1959
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,971 0001613911195 1901014701950017
410
WIDYA ADRIATI
ISTRI
07/01/1995
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,972 0001613911206 1901014911990008
410
RAZIMA NOVIANI
ANAK
09/11/1999
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,973 0001613911217 1901012208030005
410
GUSVIN TRIHANSYAH
ANAK
22/08/2003
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,974 0001613911228 1901011609060008
410
IVAN HASBIANSYAH
ANAK
16/09/2006
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,975 0001613911239 1901012708700008
415
AGUS LIONARDI
PESERTA
27/06/1970
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,976 0001613911241 1901015010640004
416
SITI ROSITA
PESERTA
10/10/1964
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,977 0001613911252 1901010903700001
417
SUHARDI
PESERTA
09/03/1970
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,978 0001613911263 1901010408690002
418
OMUDIN
PESERTA
04/08/1969
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,979 0001613911274 1901015206710001
419
JUNAINI
PESERTA
12/06/1971
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,980 0001613911285 1901011508580004
420
SAMSIAR
PESERTA
15/08/1958
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,981 0001613911296 1901014210590002
420
MELATI
ISTRI
02/10/1959
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,982 0001613911307 1901012810820002
420
RAHMAD
ANAK
28/10/1982
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,983 0001613911318 1901011212910005
420
ILHAM
ANAK
12/12/1991
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,984 0001613911329 1901010703800002
424
SOBRI
PESERTA
07/03/1980
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,985 0001613911331 1901014202850009
424
PATONA WATI
ISTRI
02/02/1985
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,986 0001613911342 1901014412040002
424
DEPITASARI
ANAK
04/12/2004
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 391 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
8,987 0001613911353 1901015701090001
424
DIVARANITA
ANAK
17/01/2009
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,988 0001613911364 1901015101110002
424
ILZAMMAH
ANAK
11/01/2011
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,989 0001613911375 1901011003560002
429
SERUN
PESERTA
10/03/1956
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,990 0001613911386 1901015002470002
430
SAHARA
PESERTA
10/02/1947
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,991 0001613911397 1901011303370001
431
SUWITO
PESERTA
13/03/1937
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,992 0001613911408 1901011805720018
431
SUPRI
ANAK
18/08/1972
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,993 0001613911419 1901011809420001
433
LA SAPTU
PESERTA
18/09/1942
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,994 0001613911421 1901014707740003
433
MURSIDAH
ANAK
07/07/1974
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,995 0001613911432 1901016408820009
433
SAHARA
ANAK
24/08/1982
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,996 0001613911443 1901014210550003
436
ASNAH
PESERTA
02/10/1955
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,997 0001613911454 1901010409500005
437
HAMDAN
PESERTA
04/09/1950
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,998 0001613911465 1901011001400001
438
SAWAL
PESERTA
10/01/1940
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
8,999 0001613911476 1901014805510001
438
ALNA
ISTRI
08/05/1951
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,000 0001613911487 1901010505820012
438
JUHERLI
ANAK
05/05/1982
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,001 0001613911498 1901014407540002
441
SUAINI
PESERTA
04/07/1954
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,002 0001613911509 1905015602900002
442
WARTINA
PESERTA
16/02/1990
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,003 0001613911511 1905012704080004
442
AGUNG SAFWAN
ANAK
27/04/2008
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,004 0001613911522 1905011704110004
442
TEGAR APRIYANTO
ANAK
17/04/2011
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,005 0001613911533 1901011211600002
445
AMIRUDIN
PESERTA
12/11/1960
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,006 0001613911544 1901016202600004
445
JATINI
ISTRI
22/02/1960
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,007 0001613911555 1901010106870002
445
JONI
ANAK
01/06/1987
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,008 0001613911566 1901010212970001
445
SATRIO
ANAK
02/12/1997
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,009 0001613911577 1901016405040003
445
MIRANDA
ANAK
24/05/2004
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 392 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,010 0001613911588 1901010503530001
450
IROT
PESERTA
05/03/1953
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,011 0001613911599 1901014107500003
450
SIMAH
ISTRI
01/07/1950
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,012 0001613911601 1901011411077530
452
HASNAH
PESERTA
24/02/1948
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,013 0001613911612 1901014829030001
453
FEBRI MAHARANI
PESERTA
08/02/1993
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,014 0001613911623 1901011305860008
454
MURDANI
PESERTA
13/05/1986
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,015 0001613911634 1901011505860005
455
MARDIANSYAH
PESERTA
15/05/1986
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,016 0001613911645 1901016805900004
455
FISKA AMEILIA
ISTRI
28/05/1990
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,017 0001613911656 1901012602100005
455
JAKA MAULANA
ANAK
26/02/2010
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,018 0001613911667 1901012108200010
458
HERYADI
PESERTA
12/10/1982
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,019 0001613911678 1901011210820010
458
HALIMAH
ISTRI
12/10/1962
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,020 0001613911689 1901015902040004
458
FEBRYANTI
ANAK
19/02/2004
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,021 0001613911691 1901015301090003
458
JENITA LESTARI
ANAK
13/01/2009
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,022 0001613911702 1901010405550003
462
SAMIN
PESERTA
04/05/1955
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,023 0001613911713 1901017001550001
462
SITI MAIMUN
ISTRI
03/01/1955
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,024 0001613911724 1901011510870001
462
FEBRYANSAH
ANAK
15/10/1989
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,025 0001613911735 1901012904890004
462
AZWAR
ANAK
29/04/1989
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,026 0001613911746 1901012210980002
462
MUHAMMAD RAFI
ANAK
22/10/1992
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,027 0001613911757 1901011701880003
467
HERMAN
PESERTA
17/01/1988
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,028 0001613911768 1901014708870010
467
ZAITUN
ISTRI
07/08/1987
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,029 0001613911779 1901011612130002
467
M.HERZAN
ANAK
16/12/2013
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,030 0001613911781 1901014210890002
470
FITRYANI
PESERTA
02/10/1989
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,031 0001613911792 1901012408740004
471
AGUSTINUS HERI BERTUS
PESERTA
24/08/1974
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,032 0001613911803 1901015912680005
471
SIRAH
ISTRI
19/12/1968
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 393 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,033 0001613911814 1901010305980002
471
HARTONO
ANAK
03/05/1998
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,034 0001613911825 1901015111050005
471
NOPITRI
ANAK
11/11/2005
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,035 0001613911836 1901010101630003
475
SOLEH
PESERTA
01/01/1963
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,036 0001613911847 1901014203700003
475
ROTENAH
ISTRI
20/05/1965
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,037 0001613911858 1901014504410003
477
SUMARNI
PESERTA
05/04/1941
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,038 0001613911869 1901011512500002
478
SIDIK GAYO
PESERTA
15/12/1950
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,039 0001613911871 1901014302580005
478
ERNA WATI
ISTRI
03/02/1958
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,040 0001613911882 1901010107440007
480
ABDURRAHMAN.D
PESERTA
01/07/1944
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,041 0001613911893 1901015111420001
480
SURNI
ISTRI
11/11/1942
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,042 0001613911904 1901010304530004
482
SAMSUDIN
PESERTA
03/04/1953
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,043 0001613911915 1901014505620003
482
JANITA
ISTRI
05/05/1962
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,044 0001613911926 1901010107870017
482
RAHMAN
ANAK
01/07/1987
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,045 0001613911937 1901011108890003
482
JOMI
ANAK
11/08/1989
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,046 0001613911948 1901010101530003
486
SAMARUDIN
PESERTA
01/01/1953
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,047 0001613911959 1901014202630002
486
IDA
ISTRI
02/02/1963
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,048 0001613911961 1901012608880003
486
CHANDRA
ANAK
26/08/1988
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,049 0001613911972 1901015908630008
489
MARSUM
PESERTA
15/08/1963
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,050 0001613911983 1901011105620001
490
SUHARJO
PESERTA
11/05/1962
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,051 0001613911994 1901015206650003
490
HOLIPAH
ISTRI
12/06/1965
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,052 0001613912005 1901010605850003
490
HENDRA
ANAK
06/05/1985
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,053 0001613912016 1901010605870008
490
APRI
ANAK
06/05/1987
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,054 0001613912027 1901010510910002
490
BAYU
ANAK
05/10/1991
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,055 0001613912038 1901016009020003
490
INA NASIA
ANAK
20/09/2002
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 394 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,056 0001613912049 1901012012040001
490
FERDYANSAH
ANAK
20/12/2004
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,057 0001613912051 1901013107840001
497
BENY SIDIK
PESERTA
31/07/1984
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,058 0001613912062 1901136511832000
497
OCHY CINTIA
ISTRI
25/11/1983
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,059 0001613912073 1901011001120002
497
BALKIS WOLZIAN
ANAK
10/01/2012
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,060 0001613912084 1901011912730002
500
ZAINI
PESERTA
19/12/1973
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,061 0001613912095 1901015503790002
500
MAIMUNAH
ISTRI
15/03/1979
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,062 0001613912106 1901015404980005
500
NELLYANA
ANAK
14/04/1998
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,063 0001613912117 1901010612030006
500
BERRI WAHYUDI
ANAK
06/12/2003
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,064 0001613912128 1901010806650002
504
SUWARTIMAN
PESERTA
08/05/1965
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,065 0001613912139 1901014809670004
504
SUBAIDAH
ISTRI
05/09/1967
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,066 0001613912141 1901013005010002
504
SUPRIYANTO
ANAK
30/05/2001
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,067 0001613912152 1901011511760003
507
MARJOHAN
PESERTA
15/11/1976
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,068 0001613912163 1901015212860008
507
DESINATALIA
ISTRI
12/12/1986
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,069 0001613912174 1901011809020005
507
SENDI
ANAK
15/09/2002
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,070 0001613912185 1901011507760007
510
MIN WALI
PESERTA
15/07/1976
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,071 0001613912196 1901014411810001
510
ASNAWATI
ISTRI
04/11/1981
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,072 0001613912207 1901010104000006
510
AZIZUL
ANAK
01/04/2000
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,073 0001613912218 1901014410070003
510
TIARA SUCI RAMADANI
ANAK
04/06/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,074 0001613912229 1901015204862000
514
ROMLI
PESERTA
11/07/1986
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,075 0001613912231 1901015204860002
514
WINDA
ISTRI
12/04/1986
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,076 0001613912242 1901011404120003
514
JEPRI APRILIAN
ANAK
01/02/2012
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,077 0001613912253 1901072203870003
517
MARTIN
PESERTA
22/03/1987
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,078 0001613912264 1901074210900002
517
SITI MAIMUNAH
ISTRI
02/10/1992
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 395 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,079 0001613912275 1901074102110001
517
SEYSYA FEBRYANTI
ANAK
01/02/1992
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,080 0001613912286 1901011708500002
520
TAMRIN
PESERTA
17/08/1950
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,081 0001613912297 1901012803030007
520
ADITTIA HUSAINI
ANAK
28/03/2003
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,082 0001613912308 1901010107620005
522
SARUN
PESERTA
01/07/1962
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,083 0001613912319 1901011905910001
522
SURY
ANAK
19/05/1991
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,084 0001613912321 1901012104980001
522
MURAT SAPUTRA
ANAK
21/04/1998
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,085 0001613912332 7010107103340000
525
THEN SOEI KHION
PESERTA
16/01/1938
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,086 0001613912343 1901011707510002
526
MANSUR
PESERTA
17/06/1951
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,087 0001613912354 1901017005560002
526
ZUBAIDAH
ISTRI
30/06/1956
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,088 0001613912365 1901011204970003
526
SYAFRIL ARDIANTO
ANAK
12/04/1997
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,089 0001613912376 1901016003900002
529
MARDIANA
PESERTA
20/03/1990
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,090 0001613912387 1901011106090003
529
JUNIARDI
ANAK
06/11/2009
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,091 0001613912398 1901015408750004
531
BUNGALIA
PESERTA
14/08/1975
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,092 0001613912409 1901011603040005
531
FADILLA SOBRI
ANAK
16/03/2004
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,093 0001613912411 1901015303070003
531
AFIFA ALZAKIRA
ANAK
13/03/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,094 0001613912422 1901012608520003
534
SYAIFUL BAHRI
PESERTA
26/08/1952
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,095 0001613912433 1901015003500001
534
SUMARNI
ISTRI
10/03/1950
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,096 0001613912444 1901010107830022
534
RUDI
ANAK
01/07/1983
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,097 0001613912455 1901010911860003
534
RISDIANTO
ANAK
09/11/1986
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,098 0001613912466 1901011506910001
534
SUCIPTO
ANAK
15/06/1991
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,099 0001613912477 1901014707630003
539
ROJIAH
PESERTA
07/07/1963
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,100 0001613912488 1901012511900005
539
HENDRA SAPUTRA
ANAK
25/11/1990
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,101 0001613912499 1901011702830001
541
BUDIMAN
PESERTA
17/02/1983
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 396 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,102 0001613912501 1901016403890007
541
PRANIDIAH
ISTRI
24/03/1989
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,103 0001613912512 1901012702080001
541
ALDI FEBRIAN
ANAK
27/02/2008
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,104 0001613912523 1901015905120001
541
ASYASAFIRA ANANTA
ANAK
19/05/2012
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,105 0001613912534 1901010103620002
545
SAMSUL
PESERTA
01/03/1962
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,106 0001613912545 1901014307640002
545
ASNAH
ISTRI
03/07/1964
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,107 0001613912556 1901011503950003
545
KUMAR
ANAK
15/03/1995
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,108 0001613912567 1901014811980003
545
SUPIAH
ANAK
06/11/1998
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,109 0001613912578 1901012004510003
549
RUSLI SAKBAN
PESERTA
20/04/1951
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,110 0001613912589 1901015004530002
549
MURNI
ISTRI
10/04/1950
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,111 0001613912591 1901014503760004
549
EKO HENDRI
ANAK
22/04/1980
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,112 0001613912602 1901012204800002
549
FITRIANTI
ANAK
24/03/1982
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,113 0001613912613 1901016403820010
549
SUSANTI
ANAK
05/03/1976
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,114 0001613912624 1901013005800002
554
YULIANDI
PESERTA
30/05/1980
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,115 0001613912635 1901012107120002
554
AKHDAN GHALI
ANAK
21/07/2012
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,116 0001613912646 1901011608670002
556
M.YAZID
PESERTA
16/08/1967
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,117 0001613912657 1901015103940001
556
BELA DEKA SARI
ANAK
10/03/1976
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,118 0001613912668 1901014903980002
556
GITA MONIKA
ANAK
09/03/1998
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,119 0001613912679 1901011412020002
556
M.DESTIAN GANDI
ANAK
14/12/2002
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,120 0001613912681 1901016308870004
560
LIA MINARTI
PESERTA
23/08/1987
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,121 0001613912714 1808011809750003
563
ERWANSYAH
PESERTA
18/09/1975
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,122 0001613912725 1808014705800005
563
ASIH RAHAYU
ISTRI
07/05/1980
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,123 0001613912736 1808014602999001
563
ERITA SARI
ANAK
06/02/1999
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,124 0001613912747 1808012409040002
563
ERIAN NOVANSYAH
ANAK
24/09/2004
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 397 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,125 0001613912758 1901011010810004
567
ADE LESMANA
PESERTA
10/10/1981
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,126 0001613912769 1901015008920008
567
INDAH RATNA.P
ISTRI
10/06/1992
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,127 0001613912771 1901012607100004
567
M.RAUHAN
ANAK
26/07/2010
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,128 0001613912782 1901012406750001
570
ERMANSYAH
PESERTA
24/06/1975
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,129 0001613912793 1901015809840003
570
JUWITATI
ISTRI
18/09/1984
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,130 0001613912804 1901015901090001
570
ANISA KEYLA
ANAK
19/01/2009
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,131 0001613912815 1901010806460004
573
AHMAD MUSLIH
PESERTA
08/06/1946
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,132 0001613912826 1901011005520001
574
SUPARDI SAKDIN
PESERTA
10/05/1952
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,133 0001613912837 1901017108580002
574
ROSMAWATI
ISTRI
31/08/1958
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,134 0001613912848 1901010206820006
576
MIFTAHULHUDA
PESERTA
02/06/1982
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,135 0001613912859 1901015606890006
576
LINA AGUSTIN
ISTRI
16/06/1989
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,136 0001613912861 1901011311100002
576
M.AZRIE LIDZINILLAH
ANAK
13/11/2010
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,137 0001613912872 1901014207720004
579
DEWI JULIARTI
PESERTA
02/07/1972
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,138 0001613912883 1901012307980004
579
TEDI HARLAN
ANAK
03/12/2000
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,139 0001613912894 1901010511720002
581
EDI KUS CANDRA
PESERTA
05/11/1972
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,140 0001613912905 1901014408940005
581
RAMAYANA C.DEWI
ANAK
04/08/1994
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,141 0001613912916 1901012203990005
581
RANDO C.PUTRA
ANAK
22/03/1999
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,142 0001613912927 1901016701080001
581
JAYAN TRIKUSUMA SARI
ANAK
27/01/2008
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,143 0001613912938 1901010606540005
585
M.TARIHORAN
PESERTA
06/06/1954
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,144 0001613912949 1901016508590005
585
SAINI
ISTRI
25/08/1959
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,145 0001613912951 1901014708850010
585
EMA PUSPITA
ANAK
07/08/1985
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,146 0001613912962 1901013009870001
585
MAJAYA TARI HORAN
ANAK
30/09/1987
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,147 0001613912973 1901012212970006
585
CHANDRA
ANAK
22/12/1997
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 398 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,148 0001613912984 1901010207550003
590
MASHUD
PESERTA
02/07/1956
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,149 0001613912995 1901015509490002
590
ASNANI
ISTRI
01/07/1949
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,150 0001613913006 1901015808570001
592
ADMIWATI
PESERTA
18/08/1957
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,151 0001613913017 1901011405710002
593
DEDE RUSMANTO
PESERTA
14/04/1971
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,152 0001613913028 1901016507780005
593
SANTI
ISTRI
05/07/1978
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,153 0001613913039 1901011706870005
595
ZUBIR KUSMAN
PESERTA
17/06/1987
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,154 0001613913041 1901015111880002
595
NURIAH
ISTRI
11/11/1988
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,155 0001613913052 1901010112070012
595
MUHHAMMAD IQBAL
ANAK
01/12/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,156 0001613913063 1901015601600004
598
SULASTRI
PESERTA
16/01/1960
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,157 0001613913074 1901010506820004
598
JOCKY RISNANTO
ANAK
05/06/1982
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,158 0001613913085 1901014803840004
598
RISA NATALIA
ANAK
08/03/1984
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,159 0001613913096 1901016701030002
598
BELA PUSPITA SARI
ANAK
27/01/2003
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,160 0001613913107 1901011008700010
602
MAULIDUR JAUN
PESERTA
10/08/1970
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,161 0001613913118 1901014706700001
602
ARMALA
ISTRI
07/06/1970
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,162 0001613913129 1901016601070003
602
IRMASAFITRI
ANAK
26/01/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,163 0001613913131 1901010308480003
605
DAMHURI
PESERTA
03/08/1948
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,164 0001613913142 1901014105510002
605
ALMA
ISTRI
01/05/1951
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,165 0001613913153 1901010404830008
607
MANAN TAKJUNG
PESERTA
04/04/1983
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,166 0001613913164 1901014404870005
607
ACI
ISTRI
04/04/1987
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,167 0001613913175 1901016012050004
607
PUTRI NATALIA
ANAK
20/12/2005
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,168 0001613913186 1901015606630003
610
ELVINA
PESERTA
16/06/1963
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,169 0001613913197 1901010705580006
611
SUMARNO
PESERTA
07/05/1958
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,170 0001613913208 1901015504830006
611
ASNA
ISTRI
15/04/1958
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 399 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,171 0001613913219 1901014503820005
613
SITI HADIJAH
PESERTA
05/03/1982
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,172 0001613913221 1901010107640006
614
ROMLAN
PESERTA
02/04/1964
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,173 0001613913232 1901015111690004
614
ARYANA
ISTRI
11/11/1969
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,174 0001613913243 1901014404950001
614
SUSILAWATI
ANAK
04/04/1995
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,175 0001613913254 1901015808980005
614
MEGAWATI
ANAK
18/08/1999
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,176 0001613913265 1901011002060004
614
HIKMAL JEFRI
ANAK
10/02/2006
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,177 0001613913276 1901010805110001
614
ALHUDA
ANAK
08/05/2011
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,178 0001613913287 1901012807680004
620
FAHRUDI
PESERTA
28/07/1968
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,179 0001613913298 1901015404750004
620
SRI NILAWATI
ISTRI
14/04/1975
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,180 0001613913309 1901012809970004
620
HARRI MASS ITANI
ANAK
28/09/1997
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,181 0001613913311 1901011803010006
620
IFANDI AULIA RACHMAN
ANAK
18/03/2001
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,182 0001613913322 1901010304040004
620
GHUAN GOBIN ADIDAYA
ANAK
03/04/2004
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,183 0001613913333 1901014611070006
620
RATU SHAHIRA
ANAK
06/11/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,184 0001613913344 1901010209130004
620
IBHRAHIM ANSHORI
ANAK
02/09/2013
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,185 0001613913355 1901012410090006
620
MUBARAK ABRAK
ANAK
24/10/2009
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,186 0001613913366 1971041909790005
628
M.SAYNI
PESERTA
19/09/1979
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,187 0001613913377 1971046706840005
628
SUNENGSIH
ISTRI
27/06/1984
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,188 0001613913388 1971046307070003
628
RESTI SAFITRI
ANAK
23/07/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,189 0001613913399 1901010806770004
631
RIBUAN
PESERTA
06/06/1977
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,190 0001613913401 1901014102870002
631
YATIMAH
ISTRI
01/02/1987
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,191 0001613913412 1901012601070005
631
ARIF PRATAMA
ANAK
26/01/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,192 0001613913423 1901011705860002
634
M.SOLEH
PESERTA
17/05/1986
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,193 0001613913434 1901085905920001
634
YULISA
ISTRI
19/05/1992
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 400 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,194 0001613913445 1901010707860000
636
ABDUL GHOFAR
PESERTA
07/07/1986
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,195 0001613913456 1901014404760010
636
NENGSIH
ISTRI
04/04/1976
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,196 0001613913467 1901015212030010
638
KARTINI
PESERTA
02/12/1983
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,197 0001613913478 1901010404570002
639
AGUNG SUTOPO
PESERTA
04/04/1957
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,198 0001613913489 1901014202600002
639
RATMILAH
ISTRI
02/02/1960
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,199 0001613913491 1901015206840003
639
RATMA YUNIARSIH
ANAK
12/06/1984
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,200 0001613913502 1901012407950003
639
YULIANI .AS
ANAK
24/07/1995
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,201 0001613913513 1901010210670001
643
AHMADI
PESERTA
02/10/1967
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,202 0001613913524 1901015611650000
643
AIDA BUDIMAN
ISTRI
16/11/1965
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,203 0001613913535 1901015603930002
643
YULISTIANA
ANAK
16/03/1993
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,204 0001613913546 1901015701010003
643
YESY NOVITA
ANAK
17/01/2001
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,205 0001613913557 1901012411340002
647
TUSIN MANSUR
PESERTA
24/11/1934
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,206 0001613913568 1901010906860000
647
JONAIDI
SUAMI
24/11/1934
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,207 0001613913579 1901016009750002
649
ANITA
PESERTA
20/09/1975
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,208 0001613913581 1901012403970004
649
KEFYN PRATAMA PUTRA
ANAK
24/03/1997
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,209 0001613913592 1901014902010003
651
GIOVANY PUTRI FERANI
PESERTA
09/02/2001
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,210 0001613913603 1901016204020003
651
LEONARDO
ANAK
22/04/2002
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,211 0001613913614 1901012307780001
653
JEFRY SETIAWAN
PESERTA
23/07/1978
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,212 0001613913625 1901015808800003
653
MUK LAN
ISTRI
18/08/1980
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,213 0001613913636 1901011804010002
653
EWALDO SHELO
ANAK
18/04/2001
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,214 0001613913647 1901010604070002
653
GLENN HANDI
ANAK
08/04/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,215 0001613913658 1901012611660002
657
TJHANG MUK SUN
PESERTA
26/11/1966
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,216 0001613913669 1901014307630000
658
DJULINA
PESERTA
26/11/1963
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 401 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,217 0001613913671 1901016709940002
658
SEBERINA NATALIA
ANAK
27/09/1994
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,218 0001613913682 1901015311960002
658
NOVIANTI CLARANTIKA
ANAK
13/11/1996
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,219 0001613913726 1901012607350000
664
NURSALIM PADMOMIJOYO
PESERTA
26/07/1935
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,220 0001613913737 1901012701610000
665
TJHIN A HON
PESERTA
27/01/1961
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,221 0001613913748 1901016608820002
665
TJHANG SOEN TIE
ISTRI
25/08/1949
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,222 0001613913759 1901010612870010
665
RICO
ANAK
25/08/1949
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,223 0001613913761 1960101431233000
668
TJHANG KHOEN TJIT
PESERTA
03/12/1933
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,224 0001613913772 1901010304780009
669
A KIUNG
PESERTA
03/04/1976
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,225 0001613913783 1901016709790007
669
KIMYOLLAZACHARY BONG
ISTRI
27/09/1979
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,226 0001613913794 1901015607080003
669
YULIANA ZACHARY
ANAK
06/07/2006
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,227 0001613913805 1901014305510001
669
BONG SUI NJONG
ANAK
03/05/1951
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,228 0001613913816 1901010303700002
673
BONG SAN SAN
PESERTA
03/03/1970
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,229 0001613913827 1901019012720000
673
RIVANDY SETIAWAN
ISTRI
19/02/1972
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,230 0001613913838 1901011810830007
673
RIDWAN SETIAWAN
ANAK
18/10/1983
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,231 0001613913849 1901015601900002
676
WINDA WELIANA SARI
PESERTA
18/01/1990
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,232 0001613913851 1901012012100539
676
KEANE FEIVAL LEVINSKY
ANAK
20/04/2008
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,233 0001613913862 1901012710130001
676
GLAVENNIO RAYNHEART
ANAK
27/10/2013
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,234 0001613913873 1901012401640001
679
TJHIE NGIT MIN
PESERTA
24/01/1964
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,235 0001613913884 1901015409860004
679
YULIANA SARI
ANAK
14/07/1986
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,236 0001613913895 1901011004970004
679
HENDRI SUSANTO
ANAK
04/10/1997
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,237 0001613913906 1901010107600010
682
SUKIRIN
PESERTA
23/11/1960
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,238 0001613913917 1901012407680002
683
ZAFYRZAL
PESERTA
24/07/1968
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,239 0001613913928 1901014510380000
683
YANA HORINA
ANAK
05/10/1938
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 402 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,240 0001613913939 1901011007870005
685
PHU SUIJKHIN
PESERTA
19/07/1967
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,241 0001613913941 1901014506780005
685
TJONG U LIE
ISTRI
05/06/1978
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,242 0001613913952 1901014819010001
685
WINDA PREL CELIA
ANAK
08/10/2001
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,243 0001613913963 1901012602020002
688
TRIO WAHYU VEBRIAN
PESERTA
26/02/2002
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,244 0001613913974 1901011806090004
688
EZA ELFANO
TAMBAHAN
18/06/2009
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,245 0001613913985 1901010403820004
690
SUROSO
PESERTA
04/03/1982
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,246 0001613913996 1901014903910003
690
NITA PRANCISCA
ISTRI
09/03/1991
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,247 0001613914007 1901010803120003
690
DEKA FERDIANTARA
ANAK
08/03/2012
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,248 0001613914018 1901012802540002
693
ERLINA
PESERTA
26/02/1954
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,249 0001613914029 1901015112550003
693
LUCI SUSANTO
SUAMI
11/12/1965
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,250 0001613914031 1901012106740001
695
YOPPI YUSDARSI
PESERTA
21/06/1974
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,251 0001613914042 1901014904770001
695
ISMALA
ISTRI
09/04/1977
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,252 0001613914053 1901011604960001
695
ANGGA SAPUTRA
ANAK
15/04/1996
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,253 0001613914064 1901010207690004
698
MURIAWAN
PESERTA
02/07/1969
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,254 0001613914075 1901015711790006
698
NOFIRA YANTI
ISTRI
17/11/1979
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,255 0001613914086 1901011308950008
698
GOFINDA ATUN
ANAK
18/03/1995
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,256 0001613914097 1901016902000003
698
RAVENA
ANAK
19/02/2000
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,257 0001613914108 1901010103080004
698
HIZAM IHSAN AL GHIFARI
ANAK
03/01/2008
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,258 0001613914119 1901012505130001
698
UWAIS AL QORNI
ANAK
25/05/2013
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,259 0001613914121 1901010107350008
704
RUSLI A.
PESERTA
01/07/1935
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,260 0001613914132 1901015805470002
704
AMINAH
ISTRI
18/05/1947
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,261 0001613914143 1901011507770004
704
HENDI SYAHRUDIN
ANAK
15/07/1977
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,262 0001613914154 1901014105830008
704
ROSITA
ANAK
01/05/1983
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 403 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,263 0001613914165 1901011011680002
708
SUKARDAN
PESERTA
10/11/1968
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,264 0001613914176 1901015008730001
708
PRIHATIN SUTRISNI
ISTRI
10/08/1973
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,265 0001613914187 1901014607970001
708
MIRADE OGI SEKARTINI
ANAK
06/07/1997
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,266 0001613914198 1901013006070001
708
RIZKY ADITYA PUTRA
ANAK
30/03/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,267 0001613914209 1901014304840001
712
RIKA
PESERTA
03/04/1984
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,268 0001613914211 1901013001670001
713
DJUPRI
PESERTA
30/01/1967
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,269 0001613914222 1901016703670003
713
HAPSAH
ISTRI
27/03/1967
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,270 0001613914233 1901014601930002
713
RISKA WAHYUNI
ANAK
06/01/1993
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,271 0001613914244 1901012004960001
713
EKI APRIYANTO
ANAK
20/04/1996
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,272 0001613914255 1901012709980005
713
EGO SEPTIADI
ANAK
27/09/1998
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,273 0001613914266 1901017107610002
718
ROMIDAH
PESERTA
31/07/1961
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,274 0001613914277 1901010712540003
719
SADURI
PESERTA
07/12/1954
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,275 0001613914288 1901014403590002
719
TOMI
SUAMI
04/03/1959
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,276 0001613914299 1901016401400003
721
KAMSIAH
PESERTA
24/01/1940
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,277 0001613914301 1901012107780003
721
EDY SUSANTO
ANAK
21/07/1978
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,278 0001613914312 1901012105840001
723
MUZZAMIL
PESERTA
21/05/1984
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,279 0001613914323 1905055001850003
723
SUSILAWATI
ISTRI
10/07/1990
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,280 0001613914334 1901015003110004
723
FINA MUZAKKIYAH
ANAK
10/03/2011
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,281 0001613914345 1901013112420006
726
MARSIDI MALIK
PESERTA
31/12/1942
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,282 0001613914356 1901015403440002
726
MARIANA
ISTRI
14/03/1944
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,283 0001613914367 1901016106670004
726
ROAINI
ANAK
21/06/1967
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,284 0001613914378 1901011409780002
729
DODDY .A
PESERTA
14/09/1978
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,285 0001613914389 1901016212720002
729
HERA YANTI
ISTRI
22/12/1972
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 404 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,286 0001613914391 1901010704940001
729
IRVAN RINALDO
ANAK
07/04/1994
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,287 0001613914402 1901012401050005
729
IKBAL DIAS PRASETYO
ANAK
24/01/2005
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,288 0001613914413 1901015708540006
733
DARNA
PESERTA
17/08/1954
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,289 0001613914424 1901012312570002
734
ALI RACHMANSYAH
PESERTA
23/12/1957
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,290 0001613914435 1901014106600005
734
SITI NURBAYA
ISTRI
01/06/1960
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,291 0001613914446 1901014409480001
736
SOLEHA
PESERTA
04/09/1948
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,292 0001613914457 1901016611770001
736
YANI
ANAK
26/11/1977
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,293 0001613914468 1901010608630005
738
PARMAN
PESERTA
06/08/1963
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,294 0001613914479 1901015307780003
738
AMINAH
ISTRI
13/07/1978
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,295 0001613914481 1901014210970003
738
YESI DO LARIA
ANAK
02/10/1997
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,296 0001613914492 1901011408030002
738
SYECH MALIKI
ANAK
14/08/2003
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,297 0001613914503 1901016201110001
738
SATIHANI
ANAK
01/02/2006
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,298 0001613914514 1901011710740001
743
ABDUL RAHMAN
PESERTA
17/10/1974
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,299 0001613914525 1901016912830005
743
NIZA DESDITI
ISTRI
29/12/1983
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,300 0001613914536 1901012708030002
743
MUHAMAD SYADAM
ANAK
27/08/2003
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,301 0001613914547 1901010312070001
743
FARAS AL FARUK
ANAK
03/12/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,302 0001613914558 1901012707670008
747
TAUFIK
PESERTA
27/07/1967
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,303 0001613914569 1910104708730001
747
SRI ERTIKA
ISTRI
07/08/1973
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,304 0001613914571 1901010301960002
747
RICCI PADANA
ANAK
03/01/1996
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,305 0001613914582 1901010111980001
747
MIRZA ASARI
ANAK
01/11/1998
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,306 0001613914593 1901015512110003
747
ZILVANA UMAYROH
ANAK
15/12/2011
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,307 0001613914604 1901010511470001
752
SUHARDI MATARIP
PESERTA
05/11/1947
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,308 0001613914615 1901015001490002
752
NAUYAH
ISTRI
10/01/1949
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 405 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,309 0001613914626 1901012210860007
752
SUKANDAR
ANAK
22/10/1986
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,310 0001613914637 1901014901720001
755
SUSANTI
PESERTA
09/01/1972
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,311 0001613914648 1901015712040001
755
PUTRI AYU DESIATI
ISTRI
17/12/2004
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,312 0001613914659 1901014507600001
757
JASIMI
PESERTA
05/07/1960
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,313 0001613914661 1901015607900002
757
SILA KUSMILA
ANAK
16/07/1990
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,314 0001613914672 1901014812930003
757
SILI ERLINA
ANAK
08/12/1993
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,315 0001613914683 1901011704520002
760
DJUNAIDI
PESERTA
17/04/1952
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,316 0001613914694 1901014510540003
760
ANA
ISTRI
05/10/1954
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,317 0001613914705 1901013007030002
762
RENDI WARIZKY
PESERTA
30/07/2003
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,318 0001613914716 1901012605100002
763
ROMI
PESERTA
06/05/2010
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,319 0001613914727 1901016411080002
764
NOVI ANGGREANI
PESERTA
24/11/2008
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,320 0001613914738 1901010809700009
765
MURSAN
PESERTA
08/09/1970
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,321 0001613914749 1901015702690002
765
SARMINI
ISTRI
17/02/1969
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,322 0001613914751 1901010801980001
765
GRIS ARIS SANDI
ANAK
08/01/1998
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,323 0001613914762 1901012006610005
768
MUCHTAR ABDULLAH
PESERTA
20/08/1961
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,324 0001613914773 1901014609700001
768
IDA RAHMAWATI
ISTRI
06/09/1970
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,325 0001613914784 1901011607970005
768
ACHMAD MAULANA
ANAK
16/07/1997
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,326 0001613914795 1901011020970000
771
SUMARDI
PESERTA
02/09/1970
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,327 0001613914806 1901011420970000
771
MARNI
ISTRI
02/09/1970
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,328 0001613914817 1901011010010001
771
MS.MARSUDI
ANAK
10/10/2001
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,329 0001613914828 1901010107860029
774
JUMADI
PESERTA
01/07/1986
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,330 0001613914839 1901014304930003
774
MARTI TRISURTINI
ISTRI
03/04/1993
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,331 0001613914841 1901014307110001
774
SULIS HARYANTI
ANAK
03/07/2011
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 406 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,332 0001613914852 1901010212780004
777
JUMADI
PESERTA
02/12/1978
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,333 0001613914863 1901016210790003
777
EKA KUSUMA WATI
ISTRI
22/10/1979
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,334 0001613914874 1901016409980001
777
LUSI ANGRAENI
ANAK
24/09/1998
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,335 0001613914885 1901014311010003
777
KONI YUDIKA
ANAK
03/11/2001
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,336 0001613914896 1901010703620005
781
ISNAN
PESERTA
07/03/1962
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,337 0001613914907 1901015009630004
781
SOLEHA
ISTRI
10/09/1963
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,338 0001613914918 1901011304590001
783
ZANI
PESERTA
03/04/1959
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,339 0001613914929 1901014505650006
783
ANITA
ISTRI
04/05/1965
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,340 0001613914931 1901010504910002
783
ANDIKA
ANAK
05/04/1991
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,341 0001613914942 1901012106820001
786
HARTONI
PESERTA
21/06/1982
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,342 0001613914953 1901012001700001
787
RISMANTO
PESERTA
20/01/1970
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,343 0001613914964 1901014107810015
787
ASMARA DEWI
ISTRI
01/07/1981
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,344 0001613914975 1901012101990005
787
YANKI PRATAMA
ANAK
21/01/1999
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,345 0001613914986 1901011708700001
790
ERDIANSYAH
PESERTA
17/08/1970
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,346 0001613914997 1901016602710001
790
HOJIJAH
ISTRI
26/02/1971
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,347 0001613915008 1901112609950001
790
ADE SYAHPUTRA
ANAK
26/09/1995
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,348 0001613915019 1901010301860003
793
SYAMSUL
PESERTA
03/01/1986
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,349 0001613915021 1901016610890005
793
SAMINA
ISTRI
26/06/1989
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,350 0001613915032 1901015504110001
793
AULIYA SARAH
ANAK
15/04/2011
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,351 0001613915043 1901011911120003
793
ZARIL
ANAK
19/11/2012
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,352 0001613915054 1901012311680006
797
MUSTAR
PESERTA
23/11/1968
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,353 0001613915065 1901015510710002
797
SOLIHA
ISTRI
15/10/1971
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,354 0001613915076 1901012010940001
797
SUHAILI
ANAK
20/10/1994
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 407 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,355 0001613915087 1901011612970003
797
JUMARI
ANAK
16/12/1997
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,356 0001613915098 1901012808010003
797
AGUNG GAMELAR
ANAK
28/08/2001
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,357 0001613915109 1901011708780007
802
KRISYANTO
PESERTA
17/08/1978
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,358 0001613915111 3518115610810006
802
RINI
ISTRI
16/09/1975
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,359 0001613915122 1901012005710004
804
SUHERLI
PESERTA
20/05/1971
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,360 0001613915133 1901014608810001
804
SAUNI
ISTRI
06/08/1981
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,361 0001613915144 1901012006000002
804
JUNIALDI SAPUTRA
ANAK
20/06/2000
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,362 0001613915155 1901012209030003
804
GUNAWAN SAPUTRA
ANAK
22/09/2003
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,363 0001613915166 1901010907070004
804
MARSEL
ANAK
09/07/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,364 0001613915177 1901012009110004
804
FARHAL A.ZAKI
ANAK
20/09/2011
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,365 0001613915188 1901012008630001
810
HAMDAN
PESERTA
20/08/1963
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,366 0001613915199 1901015706650006
810
SAMI'AH
ISTRI
17/02/1965
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,367 0001613915201 1901010703900002
810
RUSLAN
ANAK
07/03/1990
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,368 0001613915212 1901011404880006
810
RUSMAN JOHAN
ANAK
14/04/1988
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,369 0001613915223 1901016204130002
810
HIIKMAH AFRIZKI
ANAK
22/04/2013
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,370 0001613915234 1901014505920008
815
NURUL AFRIYANTI
PESERTA
05/05/1992
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,371 0001613915245 1901013112360003
816
ABDULLAH WAHAB
PESERTA
31/12/1935
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,372 0001613915256 1901010205400004
817
ABDULLAH
PESERTA
02/05/1940
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,373 0001613915267 1901015503610002
817
SUBAIDAH
ISTRI
15/01/1961
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,374 0001613915278 1901010809800004
819
DEDI SETIAWAN
PESERTA
08/09/1980
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,375 0001613915289 1901015210850005
819
NURANI
ISTRI
12/10/1985
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,376 0001613915291 1901015908120001
819
KEYLA FITRIA
ANAK
18/08/2012
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,377 0001613915302 1901010112640003
822
SUHARTO
PESERTA
01/12/1964
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 408 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,378 0001613915313 1901015112720005
822
ROSILAWATI
ISTRI
11/12/1972
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,379 0001613915324 1901013010080002
822
RIZKY OKTAVIAN
ANAK
30/10/2008
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,380 0001613915335 1901012308130002
822
FINO AL FAHRY
ANAK
23/08/2013
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,381 0001613915346 1901011701790003
826
SUPAR
PESERTA
17/07/1979
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,382 0001613915357 1901015001890003
826
RIA
ISTRI
20/01/1989
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,383 0001613915368 1901015201070003
826
DESKA MOLIDYA
ANAK
12/01/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,384 0001613915379 1901011405110003
826
MUHAMMAD ZAIN
ANAK
04/12/2011
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,385 0001613915381 3775084107431417
830
MURDIAH
PESERTA
01/07/1943
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,386 0001613915392 1901010507770009
831
INDRA
PESERTA
05/07/1977
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,387 0001613915403 1901014209840004
831
SAIDA
ISTRI
02/09/1984
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,388 0001613915414 1901011205030004
831
FARIN MAULANA
ANAK
12/05/2003
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,389 0001613915425 1901011904870001
834
FAISAL
PESERTA
19/04/1987
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,390 0001613915436 1901014112940001
834
MEGA
ISTRI
01/12/1994
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,391 0001613915447 1901015704110003
834
TASYA SABILA
ANAK
17/04/2011
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,392 0001613915458 1901012904780001
837
DARKODRI
PESERTA
29/04/1978
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,393 0001613915469 1901014805890004
837
MELANI
ANAK
08/05/1989
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,394 0001613915471 1901014811080001
837
SINDY KARTIKA
ANAK
08/11/2008
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,395 0001613915482 1901010712840001
840
PURWA SANTOSO
PESERTA
07/12/1984
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,396 0001613915493 1901016506860001
840
ROMITA
ISTRI
25/06/1986
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,397 0001613915504 1901016807080003
840
NURISTA JULIANTIN
ANAK
28/07/2008
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,398 0001613915515 1901016409120001
840
CHIKA ANGGRAINI
ANAK
24/09/2012
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,399 0001613915526 1901012410690002
844
HOLIDI
PESERTA
24/10/1969
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,400 0001613915537 1901012501940010
844
SAMSIJA
ANAK
25/01/1994
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 409 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,401 0001613915548 1901014810020002
844
WULANDARY
ANAK
08/10/2002
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,402 0001613915559 1901011310740002
847
ZULFITRI
PESERTA
13/10/1974
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,403 0001613915561 1671125212870022
847
MARTYATI
ISTRI
12/12/1987
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,404 0001613915572 1901011902120002
847
AHMAD FAUZAN
ANAK
19/02/2012
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,405 0001613915583 1901011707730004
850
SUPARNO
PESERTA
17/07/1973
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,406 0001613915594 1901016208780002
850
SUSILAWATI
ISTRI
12/08/1978
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,407 0001613915605 1901012010000005
850
YOGA ZILVANA
ANAK
20/10/2000
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,408 0001613915616 1901012803070008
850
FAREL AZARI
ANAK
29/03/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,409 0001613915627 1901013106110002
850
VIGO ALFINO
ANAK
31/05/2011
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,410 0001613915638 1901011410130004
850
FARAH FADILLAH
ANAK
14/10/2013
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,411 0001613915649 1604102301840004
856
SUPRA YITNO
PESERTA
23/01/1984
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,412 0001613915651 3204286312930013
856
NUNUY NURAENI
ISTRI
28/11/1992
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,413 0001613915662 1901012806110001
856
DANANG ROSADI
ANAK
28/06/2011
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,414 0001613915673 1901011203140004
856
MUHAMMAD IKHJAFADINNO
ANAK
12/03/2014
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,415 0001613915684 1901016605650001
860
KESSI
PESERTA
26/05/1965
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,416 0001613915695 1901012008890008
860
JOKO PURNOMO
ANAK
20/08/1989
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,417 0001613915706 1901012407730003
862
SUGIANTO
PESERTA
24/07/1973
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,418 0001613915717 1901015308740006
862
AMILIA
ISTRI
13/08/1974
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,419 0001613915728 1901014304960003
862
SELLA
ANAK
03/04/1996
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,420 0001613915739 1901012209990002
862
ANDES
ANAK
22/09/1999
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,421 0001613915741 1901016710050002
862
FITRI
ANAK
27/10/2006
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,422 0001613915752 1901016704110001
862
SUCI ADELIA
ANAK
27/04/2011
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,423 0001613915763 1901010705880008
868
ANDI
PESERTA
07/05/1988
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 410 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,424 0001613915774 1901017008120004
868
YULIA AGUSTIA
ANAK
30/08/2012
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,425 0001613915785 1901011805530002
870
USMAN
PESERTA
18/05/1958
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,426 0001613915796 1901015211680004
870
SAINAB
ISTRI
12/11/1968
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,427 0001613915807 1901011107980011
870
AGUS
ANAK
11/07/1998
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,428 0001613915818 1901010512710003
873
RAHMAT HIDAYAT
PESERTA
05/12/1971
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,429 0001613915829 1901014810790004
873
DESRI
ISTRI
08/10/1979
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,430 0001613915831 1901012401080003
873
AHMAD MUSTOMI
ANAK
24/01/2008
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,431 0001613915842 1901011909090001
876
HAIDAL VITRA
PESERTA
19/09/2009
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,432 0001613915853 1901012210890004
877
EDI SAPUTRA
PESERTA
22/10/1989
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,433 0001613915864 1901016010950002
877
WIDYAWATI NINGSIH
ISTRI
10/10/1995
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,434 0001613915875 1901010201890008
879
HARYANTO
PESERTA
02/01/1988
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,435 0001613915886 1901014606700002
879
RUSMALA
ISTRI
06/06/1970
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,436 0001613915897 1901011206990005
879
AGUS HARIANTO
ANAK
12/06/1999
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,437 0001613915908 1901011612040004
879
FIRDAUS
ANAK
16/12/2004
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,438 0001613915919 1901011509070002
879
BUDI SETIAWAN
ANAK
25/02/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,439 0001613915921 1901013108690001
884
HERMANTO
PESERTA
31/08/1969
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,440 0001613915932 1901015208670003
884
ARNISAH
ISTRI
12/08/1967
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,441 0001613915943 1901010609950003
884
ANGGA SAPUTRA
ANAK
06/09/1995
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,442 0001613915954 1901130620030000
884
ACHMAD YUNIZAR
ANAK
13/06/2003
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,443 0001613915965 1901015301930001
888
RITA ARDINI
PESERTA
13/01/1993
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,444 0001613915976 1901015405700003
889
AINI
PESERTA
14/05/1976
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,445 0001613915987 1901013012970005
889
MUHAMMAD ARIS SYAFI'I
ANAK
30/12/1992
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,446 0001613915998 1901011812940001
889
DIEKA SULAIMANDRA
ANAK
15/12/1994
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 411 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,447 0001613916009 1901010512000002
889
DEFRI RAHMANDANI
ANAK
05/12/2000
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,448 0001613916011 1901015110750004
893
SUMIATI
PESERTA
11/10/1975
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,449 0001613916022 1901016505980002
893
MINAH
ANAK
25/05/1998
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,450 0001613916033 1901011809890005
895
KIMAN
PESERTA
18/09/1989
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,451 0001613916044 1901012005720003
896
SARJONO
PESERTA
20/05/1977
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,452 0001613916055 1901016312810001
896
MARYANA
ISTRI
23/12/1981
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,453 0001613916066 1901014508010004
896
GUSTIA MUNSTINO
ANAK
05/08/2001
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,454 0001613916077 1901015302060003
896
SUCI SAFITRI
ANAK
13/02/2006
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,455 0001613916088 1901011209120002
896
GURUH FAJRI AZZAKY
ANAK
12/09/2012
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,456 0001613916099 1901011007440001
901
GUNG
PESERTA
10/07/1944
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,457 0001613916101 1901015206620006
901
IMAN
ANAK
12/06/1962
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,458 0001613916112 1901010611980002
901
BENI SAPUTRA
ANAK
06/11/1998
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,459 0001613916123 1901010602020003
901
ARIFIN
ANAK
06/02/2002
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,460 0001613916134 1901010202460001
905
PONIMIN
PESERTA
02/02/1946
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,461 0001613916145 1901014606510005
905
WAKINA
ISTRI
06/06/1951
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,462 0001613916156 1901010211920003
905
MARTONO RINDAH RIYANTO
ANAK
02/11/1992
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,463 0001613916167 1901010101490010
908
IPNA
PESERTA
01/01/1949
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,464 0001613916178 1901011091800006
908
WADI
ANAK
09/10/1980
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,465 0001613916189 1901011105810004
908
IWAN
ANAK
11/05/1981
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,466 0001613916191 1901011709510002
911
SAMARUDIN
PESERTA
17/09/1951
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,467 0001613916202 1901015408610002
911
ANA
ISTRI
14/08/1961
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,468 0001613916213 1901015504720008
913
SURYANI
PESERTA
15/04/1972
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,469 0001613916224 1901010705980001
913
ALADIN
ANAK
07/05/1998
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 412 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,470 0001613916235 1901010909720002
915
SLAMET HARYANTO
PESERTA
09/09/1972
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,471 0001613916246 1901014207730003
915
MASIAH
ISTRI
02/07/1973
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,472 0001613916257 1901010202940003
915
WAHID WAHYUDI
ANAK
02/02/1994
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,473 0001613916268 1901010502970002
915
SUTRIS
ANAK
05/02/1997
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,474 0001613916279 1901016507000001
915
EMA WATI
ANAK
25/07/2000
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,475 0001613916281 1901014904630001
920
SUHARTINI
PESERTA
09/04/1963
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,476 0001613916292 1901010107900034
920
SUHENDRI
ANAK
01/06/1990
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,477 0001613916303 1901010705960002
920
SUHENDRA
ANAK
07/05/1996
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,478 0001613916314 1901012506650002
923
HARTONO
PESERTA
25/06/1965
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,479 0001613916325 1901015403700003
923
MARIANA
ISTRI
14/03/1970
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,480 0001613916336 1901012505970004
923
JUMADI
ANAK
25/05/1997
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,481 0001613916347 1901015006070002
926
ADINDA FRANSICA INDRI
PESERTA
10/06/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,482 0001613916358 1901010903760002
927
MARWANI
PESERTA
09/03/1976
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,483 0001613916369 1901015206750001
927
SRI WAHYU NENGSIH
ISTRI
12/06/1975
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,484 0001613916371 1901016305020002
927
DEWI MARCELINA
ANAK
23/05/2002
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,485 0001613916382 1901015112120002
927
FARAH DESTA
ANAK
11/05/2002
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,486 0001613916393 1901010510690005
931
RIBUT BUDIYANTORO
PESERTA
05/10/1969
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,487 0001613916404 1901014503690002
931
NURSIAH
ISTRI
05/03/1969
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,488 0001613916415 1901012705970000
931
ADE DWI KURNIAWAN
ANAK
27/05/1997
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,489 0001613916426 1901014305040002
931
TRI AMBARYANI
ANAK
03/05/2004
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,490 0001613916437 1901010903750006
935
HARYONO
PESERTA
09/03/1975
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,491 0001613916448 1901015005770007
935
MAINUN
ISTRI
10/05/1977
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,492 0001613916459 1901011407960009
935
WAHYU SUHENDRA
ANAK
14/07/1996
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 413 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,493 0001613916461 1901014711980003
935
MAYA HARTATI
ANAK
07/11/1998
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,494 0001613916472 1901016208050002
935
SHERLY AGUSTINA
ANAK
22/08/2005
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,495 0001613916483 1901011110090000
935
ILHAM ANUGRAH
ANAK
11/11/2009
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,496 0001613916494 1901012105680004
941
KARMA
PESERTA
21/05/1968
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,497 0001613916505 1901015511730004
941
YUNIARTI
ISTRI
15/11/1973
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,498 0001613916516 1901011911930002
941
YOPIE WIDIANTO
ANAK
19/11/1993
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,499 0001613916527 1901010102010004
941
YOGIE THOMAS
ANAK
01/02/2001
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,500 0001613916538 1901014707070003
941
KLAURA RINDU CHEICHE
ANAK
07/07/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,501 0001613916549 1901011502740001
946
ABDUL FATAH
PESERTA
15/02/1974
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,502 0001613916551 1901014602770002
946
LILIYANTY
ISTRI
06/02/1977
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,503 0001613916562 1901015508050008
946
ADINDA TIARA POLE
ANAK
15/08/2005
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,504 0001613916584 1901011707810004
950
SIDIK
PESERTA
17/07/1981
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,505 0001613916595 1901014107770024
950
MARIYANA
ISTRI
01/07/1977
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,506 0001613916606 1901016401000002
950
ZAKKIA
ANAK
24/01/2000
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,507 0001613916617 1901015112080002
950
JANATU SYADZA
ANAK
11/12/2008
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,508 0001613916628 1901010403810001
954
AKBAR
PESERTA
04/03/1981
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,509 0001613916639 1901014707810001
954
SAKINA
ISTRI
07/07/1981
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,510 0001613916641 1901010401010001
954
FIRMANDO
ANAK
01/01/2001
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,511 0001613916652 1901011106060001
954
FIRTO ADRESTO
ANAK
01/06/2006
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,512 0001613916663 1901012305540001
958
SAMSUDIN
PESERTA
23/05/1954
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,513 0001613916674 1901015503690004
958
KARTINI
ISTRI
15/03/1969
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,514 0001613916685 1901010204890004
958
MADA
ANAK
02/04/1989
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,515 0001613916696 1901011205910004
958
KOMAR
ANAK
12/05/1991
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 414 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,516 0001613916707 1901015708940003
958
ARDILA
ANAK
17/08/1994
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,517 0001613916718 1901010411530001
963
MANSYUR
PESERTA
04/11/1953
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,518 0001613916729 1901012008790005
964
HERWANTO
PESERTA
20/08/1979
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,519 0001613916731 1901015709850007
964
PATIMAH
ISTRI
17/09/1985
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,520 0001613916742 1901012606030004
964
YOGA SANJAYA SAPUTRA
ANAK
26/06/2003
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,521 0001613916753 1901012904110003
964
AFDAL SYAFAN
ANAK
29/04/2011
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,522 0001613916764 1901010109490000
968
SYAPI'IE
PESERTA
01/09/1949
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,523 0001613916775 1901014209510002
968
HAJIJAH
ISTRI
02/09/1951
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,524 0001613916786 1901012902720001
968
SAPRIHADI
ANAK
29/02/1972
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,525 0001613916797 1901013010760002
968
HERIYANTO
ANAK
30/10/1976
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,526 0001613916808 1901015506770003
972
YATI
PESERTA
15/06/1977
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,527 0001613916819 1904062201720001
973
ABDULLAH SANI
PESERTA
22/01/1972
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,528 0001613916821 1904066001820001
974
DANTI
PESERTA
20/01/1982
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,529 0001613916832 1901011012640003
975
LUKMAN
PESERTA
10/12/1994
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,530 0001613916843 1901016708720006
975
ZALINA
ISTRI
27/08/1972
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,531 0001613916854 1901012707900002
975
GUNTUR
ANAK
27/07/1990
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,532 0001613916865 1901014704960006
975
RESTU DAMAYANTI
ANAK
07/04/1996
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,533 0001613916876 1901015810990001
975
DINI RESTUTI
ANAK
18/10/1999
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,534 0001613916887 1901016704010003
975
RESTIANA
ANAK
27/04/2001
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,535 0001613916898 1901016808050001
975
ANNISA ADINDA
ANAK
28/08/2005
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,536 0001613916909 1901015411080001
975
SHIFA ADILA
ANAK
14/11/2008
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,537 0001613916911 1901010107750023
983
SUNI
PESERTA
01/07/1975
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,538 0001613916922 1901016102760002
983
SAMSIAH
ISTRI
21/02/1976
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 415 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,539 0001613916933 1901011501950006
983
RAHUL
ANAK
15/01/1995
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,540 0001613916944 1901010910980004
983
MARWAN
ANAK
09/10/1998
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,541 0001613916955 1901015411030002
983
SARAH
ANAK
14/11/2003
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,542 0001613916966 1901011705060003
983
ULAY
ANAK
17/05/2006
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,543 0001613916977 1901012901090001
983
HASBY
ANAK
29/01/2009
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,544 0001613916988 1901015803490001
990
SIMAH
PESERTA
18/03/1949
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,545 0001613916999 1901011402770003
990
ASMADI
ANAK
14/02/1977
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,546 0001613917001 1901011201810007
990
KUSRIANTO
ANAK
12/08/1981
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,547 0001613917012 1901011501860005
990
SURATNO
ANAK
15/01/1986
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,548 0001613917023 1901012707740002
994
IDHAM MUHAAMMAD
PESERTA
27/07/1974
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,549 0001613917034 1901014905780001
994
JUWITA
ISTRI
09/05/1978
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,550 0001613917045 1901010409970004
994
RIO NOMIZA
ANAK
04/09/1997
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,551 0001613917056 1901016312000003
994
NURUL INDIANI
ANAK
23/12/2000
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,552 0001613917067 1901012407740001
998
SUHAIMI
PESERTA
24/07/1974
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,553 0001613917078 1901016005770003
998
SUAINI
ISTRI
20/05/1977
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,554 0001613917089 1901010201010006
998
JUANDA
ANAK
02/01/2001
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,555 0001613917091 1901012501130004
998
NAZAR
ANAK
25/01/2013
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,556 0001613917102 1901012005510004
1002
ROMLI DUL
PESERTA
20/05/1951
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,557 0001613917113 1901014107550019
1002
SUMARNI
ISTRI
01/07/1955
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,558 0001613917124 1901011612830004
1002
SUBARI
ANAK
16/12/1983
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,559 0001613917135 1901011802820003
1005
BENI EKSA PUTRA
PESERTA
18/02/1982
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,560 0001613917146 1901026904860007
1005
MELINDO
ISTRI
29/04/1986
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,561 0001613917157 1901016505520001
1007
SAURA
PESERTA
25/05/1952
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 416 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,562 0001613917168 1901016811580003
1008
ROBAYA
PESERTA
28/11/1958
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,563 0001613917179 1901014010766003
1008
ANYA
ISTRI
01/07/1966
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,564 0001613917181 1901010107920016
1008
INDRIS
ANAK
01/01/1992
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,565 0001613917192 1901015210510003
1011
SUPARMI
PESERTA
20/10/1951
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,566 0001613917203 1901013004440001
1011
SUPRAPTO
ISTRI
30/04/1944
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,567 0001613917214 1901011304510001
1013
ARTONI ARIP
PESERTA
13/04/1951
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,568 0001613917225 1901014301510003
1014
ROHINA
PESERTA
03/01/1951
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,569 0001613917236 3277020207860001
1015
ROZALI
PESERTA
01/07/1958
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,570 0001613917247 3277021010600013
1016
YAYAN HARYANI
PESERTA
10/10/1960
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,571 0001613917258 1901014107490033
1017
ANA
PESERTA
01/07/1949
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,572 0001613917269 1901011405670002
1018
SUPARMAN
PESERTA
14/05/1967
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,573 0001613917271 1901015608680002
1019
ZAIMI
PESERTA
16/08/1968
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,574 0001613917282 1901010204700002
1020
SUHERMAN
PESERTA
02/04/1970
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,575 0001613917293 1901014305760002
1020
ASIAH
ISTRI
03/05/1976
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,576 0001613917304 1901011202010002
1020
RIYAN SURANTO
ANAK
12/02/2001
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,577 0001613917315 1901011203070001
1020
DELTA
ANAK
12/03/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,578 0001613917326 1901010503930002
1020
SURYANTO
ANAK
05/03/1993
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,579 0001613917337 1901012711000001
1020
RAMADANI
ANAK
27/11/2000
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,580 0001613917348 1901011204660003
1026
BAGINDA
PESERTA
12/04/1966
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,581 0001613917359 1901014104690001
1026
HAMINAH
ISTRI
01/04/1969
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,582 0001613917361 1901015803950001
1026
SIBTI MARFIANA
ANAK
18/03/1995
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,583 0001613917372 1901016312960002
1026
DENA ARGINDA
ANAK
23/12/1996
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,584 0001613917383 1901010402030004
1026
LUCKY FERIYANSYAH
ANAK
04/02/2003
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 417 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,585 0001613917394 1901015705050004
1026
ZOLI
ANAK
17/05/2005
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,586 0001613917405 1901010507870008
1032
HERI KISWANTO
PESERTA
05/07/1987
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,587 0001613917416 1901016407890002
1032
RUSMITA
ISTRI
24/07/1989
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,588 0001613917427 1901014509070003
1032
HERLINA SYAILARIDA
ANAK
05/09/2007
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,589 0001613917438 1901016805110006
1032
AISYAH ERALITA
ANAK
28/05/2011
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,590 0001613917449 1901010801820003
1036
MUHAMMAD ALFIAN
PESERTA
06/01/1962
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,591 0001613917451 1901015112860006
1036
ROMLAH
ISTRI
11/12/1986
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,592 0001613917462 1901010702080001
1036
JEFRI
ANAK
07/02/2008
SINAR BARU
01/05/2015
AKTIF
19,225
22/04/2015
9,593 0001613917473 1901030810250001
1039
BOEN NGIAT DJIM
PESERTA
10/08/1925
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
9,594 0001613917484 1901035404530003
1040
LIE A NYUN
PESERTA
14/04/1953
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
9,595 0001613917495 1901034907390002
1041
NG SAK THOE
PESERTA
06/09/1939
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
9,596 0001613917506 1901035007540001
1042
DJOLIYA
PESERTA
06/10/1954
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
9,597 0001613917517 1901034301560001
1043
LIE MIE TJIA
PESERTA
01/03/1956
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
9,598 0001613917528 1901035211640001
1044
HATIJAH
PESERTA
12/11/1964
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
9,599 0001613917539 1901036306620000
1045
ROSMANI
PESERTA
23/07/1962
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
9,600 0001613917541 1901035610550000
1046
ENDANG SUPRIHATIN
PESERTA
16/10/1955
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
9,601 0001613917552 1901033260555001
1047
TJEN NGIAN DJANG
PESERTA
26/05/1955
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
9,602 0001613917563 1901036711620001
1048
A NYONG
PESERTA
27/11/1962
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
9,603 0001613917574 1901031007350000
1049
LIOE DJAN HO
PESERTA
06/10/1935
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
9,604 0001613917585 1901031205780000
1050
FEN DJUNG
PESERTA
05/12/1978
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
9,605 0001613917596 1901034204790001
1050
SANTIE
ISTRI
02/04/1979
BATURUSA
01/05/2015
AKTIF
19,225
22/04/2015
9,606 0001613917607 1901050709550001
1052
SUDARMAN
PESERTA
07/09/1955
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,607 0001613917618 1901055010660004
1053
ASNI
PESERTA
10/10/1966
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 418 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,608 0001613917629 1901057112360003
1054
PATIMA
PESERTA
31/12/1936
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,609 0001613917631 1901054101470003
1054
SOPIANTI
ANAK
01/01/1947
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,610 0001613917642 1901050403870002
1056
ABDUL GAFUR
PESERTA
04/03/1987
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,611 0001613917653 1901051012640004
1057
MUSA
PESERTA
10/12/1964
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,612 0001613917664 1901054505380001
1058
MARIANGAN
PESERTA
05/05/1938
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,613 0001613917675 1901056711850003
1059
UCI
PESERTA
27/11/1985
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,614 0001613917686 1901056812040003
1059
NIKEN
ANAK
28/12/2004
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,615 0001613917697 1901052210720001
1061
M. BOCHARI MUSLIM
PESERTA
22/10/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,616 0001613917708 1901054107560032
1062
MENA
PESERTA
01/07/1956
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,617 0001613917719 1901050111550002
1063
ILYAS
PESERTA
01/11/1955
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,618 0001613917721 1901055708580002
1064
SUMARNI
PESERTA
17/08/1958
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,619 0001613917732 1901056711540001
1065
SUWANI
PESERTA
27/11/1954
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,620 0001613917743 1901056407290001
1066
SUPIAH
PESERTA
24/07/1929
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,621 0001613917754 1901055312510002
1067
SAUYAH
PESERTA
13/12/1951
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,622 0001613917765 1901050202460003
1068
MUSTAPA
PESERTA
02/02/1946
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,623 0001613917776 1901050107530024
1069
ABDUL MUIN
PESERTA
01/07/1953
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,624 0001613917787 1901054107730018
1070
MARIANI
PESERTA
01/07/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,625 0001613917798 1901050108480001
1071
HANAFI
PESERTA
01/08/1948
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,626 0001613917809 1901054305500001
1071
MARIANA
ISTRI
03/05/1950
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,627 0001613917811 1901052101720001
1073
HERMANSYAH
PESERTA
21/01/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,628 0001613917822 1901054501830001
1073
ROSITA
ISTRI
05/01/1983
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,629 0001613917833 1901055708750001
1075
SRIYATUN
PESERTA
17/08/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,630 0001613917844 1901051003960002
1075
WAHYU PRASETIYO
ANAK
10/03/1996
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 419 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,631 0001613917855 1901051301810003
1077
SUHERMAN
PESERTA
13/01/1981
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,632 0001613917866 1901056311820001
1077
SELLY PAWINDA
ISTRI
23/11/1982
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,633 0001613917877 1901052604750002
1079
BUDI
PESERTA
26/04/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,634 0001613917888 1901012009630002
1080
SULAIMAN
PESERTA
05/07/1963
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,635 0001613917899 1901015201820007
1080
HERLELA
ISTRI
12/01/1982
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,636 0001613917901 1901054107900011
1082
ERNAWATI
PESERTA
06/05/1990
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,637 0001613917912 1901051610660001
1083
M. JAZULI
PESERTA
16/10/1966
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,638 0001613917923 1901050205650001
1084
MISKARI
PESERTA
02/05/1965
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,639 0001613917934 1901054206600001
1085
ROHANA
PESERTA
02/06/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,640 0001613917945 1901055507470001
1086
PATIMAH
PESERTA
15/07/1947
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,641 0001613917956 1901055908640005
1087
NURASIAH
PESERTA
19/08/1964
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,642 0001613917967 1901054705800002
1088
MISDA
PESERTA
07/05/1980
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,643 0001613917978 1901056009730001
1089
MARYANA
PESERTA
06/05/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,644 0001613917989 1901051805690001
1090
ARNADI
PESERTA
18/05/1969
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,645 0001613917991 1901051808740001
1091
ROMLAN
PESERTA
18/08/1974
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,646 0001613918002 1901024412770001
1091
SURATNA
ISTRI
27/09/1977
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,647 0001613918013 1901051306060002
1091
ANDRE
ANAK
13/06/2006
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,648 0001613918024 1901056208820001
1094
SUSILAWATI
PESERTA
22/08/1982
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,649 0001613918035 1901051906810004
1095
SUPARMAN
PESERTA
19/06/1981
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,650 0001613918046 1901055908760002
1095
YUYUN
ISTRI
19/08/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,651 0001613918057 1901051511110001
1095
SUPARDI
ANAK
15/11/2011
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,652 0001613918068 1901051202670001
1098
SIMON
PESERTA
12/02/1967
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,653 0001613918079 1901014404820006
1098
LAILA
ISTRI
04/04/1982
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 420 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,654 0001613918081 1901012303010001
1098
NADI M ARDIANSYAH
ANAK
23/03/2001
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,655 0001613918092 1901051111920003
1101
DONI
PESERTA
11/11/1992
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,656 0001613918103 1901054308940001
1101
EKI SUMIATI
ISTRI
03/08/1994
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,657 0001613918114 1901051210120001
1101
DAPA
ANAK
12/10/2010
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,658 0001613918125 1901055510780001
1104
KARTINI BR SIHITE
PESERTA
15/10/1978
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,659 0001613918136 1901055204780003
1105
SRI NINGSIH
PESERTA
12/04/1978
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,660 0001613918147 1901056006020002
1105
MELANI SAPUTRI
ANAK
20/05/2002
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,661 0001613918158 1901054633060002
1105
MALINDA SINTIA BELLA
ANAK
06/03/2006
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,662 0001613918169 1901051707090002
1105
FERRO JULNATAN
ANAK
17/07/2009
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,663 0001613918171 1901055909760001
1109
NERI
PESERTA
19/09/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,664 0001613918182 1901052006090001
1109
RENDI DARLIUS
ANAK
20/06/2009
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,665 0001613918193 1901052406110001
1109
KALVIN STEFEN
ANAK
24/06/2011
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,666 0001613918204 1901055605120001
1109
NATALY ANGEL C
ANAK
16/05/2012
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,667 0001613918215 1901055009830003
1113
DARNIATI
PESERTA
10/09/1983
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,668 0001613918226 1901052809040004
1113
SEPTIAN MAULANA
ANAK
28/09/2004
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,669 0001613918237 1901054560310002
1113
CITRA WIRDA SYAHRI
ANAK
06/03/2010
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,670 0001613918248 1901052310110002
1113
ZULFANO HADI
OKTARIANSYAH
ANAK
23/10/2011
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,671 0001613918259 1901056311070001
1117
PUTRI HARDIANTI
PESERTA
23/11/2007
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,672 0001613918261 1901051105700001
1118
ISKANDAR
PESERTA
11/06/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,673 0001613918272 1901054103730001
1118
MALIJA
ISTRI
01/03/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,674 0001613918283 1901054611980002
1118
RIKA NOVARI
ANAK
06/11/1998
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,675 0001613918294 1901056012000002
1118
DESI ISMA SARI
ANAK
20/12/2000
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,676 0001613918305 1901055606050004
1118
DESVI YULIANTI
ANAK
16/06/2005
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 421 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,677 0001613918316 1901050105600001
1123
SUHARDI
PESERTA
01/05/1980
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,678 0001613918327 1901055003630001
1123
NURYATI
ISTRI
10/03/1983
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,679 0001613918338 1901051708910001
1123
ERWAN GUSTIAWAN
ANAK
17/08/1991
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,680 0001613918349 1901055805020002
1123
REGITA PUTRI NEYLANNI
ANAK
18/05/2002
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,681 0001613918351 1901051407040001
1123
MUHAMMAD ALFIN AKBAR
ANAK
14/07/2004
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,682 0001613918362 1901051804710002
1128
MOH. DODY PARMONO
PESERTA
18/04/1971
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,683 0001613918373 1901056705710002
1128
DWI ARTINI
ISTRI
27/05/1971
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,684 0001613918384 1901055510010003
1128
DINDA ISRA OKTARINI

SAMBERIA
ANAK
15/10/2001
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,685 0001613918395 1901054609030002
1128
DITA RETNO SEVI WULANDARI ANAK
06/09/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,686 0001613918406 1901052309070001
1128
DIMAS ADITYA RIZKY

RAMADAN
ANAK
23/09/2007
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,687 0001613918417 1901051403090001
1128
DITO FAJAR MARCELLINO
ANAK
14/03/2009
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,688 0001613918428 1901050205600002
1134
ATUNG S
PESERTA
02/05/1969
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,689 0001613918439 1901058711930003
1134
SHELFI NOVIALIM
ANAK
27/11/1993
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,690 0001613918441 1901051901000002
1134
RICKY SETYAWAN
ANAK
19/01/2000
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,691 0001613918452 1901011004500001
1137
THAMRIN
PESERTA
10/04/1950
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,692 0001613918463 1901014502640001
1137
MALUNA
ISTRI
06/02/1964
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,693 0001613918474 1901050109600001
1139
RAHMAN
PESERTA
01/09/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,694 0001613918485 1901055111700001
1139
ROHAYA
ISTRI
11/11/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,695 0001613918496 1901051411940001
1139
YOGI DWI ANDRIAN
ANAK
14/11/1994
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,696 0001613918507 1901050812010001
1139
TRI RAMADANIATI
ANAK
08/12/2001
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,697 0001613918518 1901055910060001
1139
SUCI RAMADANI
ANAK
19/10/2006
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,698 0001613918529 1901052711540001
1144
ALMAN AYUB
PESERTA
27/11/1954
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 422 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,699 0001613918531 1901056209610001
1144
SUSILAWATI
ISTRI
22/09/1961
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,700 0001613918542 1901050901050001
1144
REZA FAHLEVY
ANAK
09/01/2005
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,701 0001613918553 1901050204060001
1147
APRIANSYAH
PESERTA
02/04/2006
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,702 0001613918564 1901055510760001
1148
RITA
PESERTA
16/10/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,703 0001613918575 1901050110010002
1148
RESFANI IRVAN
ANAK
01/10/2001
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,704 0001613918586 1901051304130002
1150
ALDI KRISTIAN PIRDAUS
PESERTA
13/04/2013
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,705 0001613918597 1901055911550002
1151
SUI SIAT
PESERTA
19/11/1955
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,706 0001613918608 1901052102670002
1152
JAMIAH
PESERTA
15/10/1969
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,707 0001613918619 1901051908060002
1152
MELAN AZRIL
ANAK
19/08/2006
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,708 0001613918621 1901056610060003
1154
SUMIATI
PESERTA
12/08/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,709 0001613918632 1901054606030001
1154
PUTRI INDAH PURWATI
ANAK
28/10/2006
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,710 0001613918643 1901051911660001
1156
LIMIN
PESERTA
19/11/1966
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,711 0001613918654 1901055303790001
1156
SUZANA
ISTRI
13/03/1979
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,712 0001613918665 1901055806020001
1156
LINA LIANA
ANAK
18/05/2002
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,713 0001613918676 1901056306050005
1156
LILIS SURYANI
ANAK
23/06/2005
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,714 0001613918687 1901051012050003
1160
M.ERIANDI DESWANTARA
PESERTA
10/12/2005
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,715 0001613918698 1901051001110002
1160
LUTHFI MUZAKKI
ANAK
10/01/2011
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,716 0001613918709 1607070107600074
1162
SUHARYONO
PESERTA
01/07/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,717 0001613918711 1607075404790001
1162
ISPURWATI
ISTRI
14/04/1978
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,718 0001613918722 1901055112570001
1164
RUSMI
PESERTA
11/12/1957
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,719 0001613918733 1901054406600002
1165
ROSNI
PESERTA
04/06/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,720 0001613918744 1901052803470002
1166
MOEK TJHOY
PESERTA
28/03/1947
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,721 0001613918755 1901056106520002
1166
ALINA
ISTRI
21/06/1952
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 423 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,722 0001613918777 1901052111780001
1169
SUARSA
PESERTA
21/11/1978
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,723 0001613918788 1901054705840001
1169
AYUT
ISTRI
07/05/1984
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,724 0001613918799 1901056904030001
1169
APRIYANA
ANAK
29/04/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,725 0001613918801 1901051903100002
1169
MUHAMMAD SATRIO
ANAK
19/03/2010
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,726 0001613918812 1901055308130002
1169
AGISTA SAPITRI
ANAK
13/08/2013
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,727 0001613918823 1901052304860003
1174
ALIP ROHANA
PESERTA
23/04/1986
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,728 0001613918834 3602184412890003
1174
KHODIJAH
ISTRI
04/12/1989
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,729 0001613918845 1901056102140003
1174
NUR ALYA
ANAK
21/02/2014
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,730 0001613918856 1901050701820008
1177
SAHARI RAMADANI
PESERTA
07/01/1982
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,731 0001613918867 1901055808870001
1177
KASMAH
ISTRI
18/08/1987
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,732 0001613918878 1901052811130001
1177
ARZIEL FRANSDAKA
ANAK
28/11/2013
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,733 0001613918889 1901051010790003
1180
HADI SUKANTO
PESERTA
10/10/1979
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,734 0001613918891 1901054508070006
1180
DISKA ANGGUN D.G
ANAK
05/08/2007
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,735 0001613918902 1901051604130001
1180
APRILIAN AKBAR
ANAK
16/04/2013
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,736 0001613918913 1901052003510001
1183
ROMLI
PESERTA
20/03/1951
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,737 0001613918924 1901054507690001
1183
MURISAH
ISTRI
05/07/1969
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,738 0001613918935 1901052001850001
1185
IRWANDI
PESERTA
20/01/1985
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,739 0001613918946 1901054306870002
1185
ZUHRIYANI
ISTRI
03/06/1987
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,740 0001613918957 1901051011780002
1187
AHMAD MAFAKHIR
PESERTA
10/11/1978
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,741 0001613918968 1901055003820001
1187
LINDA HARTATI
ISTRI
10/03/1982
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,742 0001613918979 1901051108030003
1187
MUHAMMAD IMAM BAIHAQI
ANAK
11/08/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,743 0001613918981 1901055006790905
1190
NURITA
PESERTA
10/06/1979
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,744 0001613918992 1905030804560001
1191
ROMAWI
PESERTA
08/04/1956
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 424 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,745 0001613919003 1905036706720001
1191
SAIDA
ISTRI
27/06/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,746 0001613919014 1901054408070001
1193
YOFA CHOIRUNNISA
PESERTA
04/08/2007
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,747 0001613919025 1901055910110001
1193
AKIFA SABARA
ANAK
18/10/2011
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,748 0001613919036 1901050507140001
1193
MUHAMAD FADHIL ASYARI
ANAK
05/07/2014
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,749 0001613919047 1901050412730003
1196
KURNIAL SUWATA
PESERTA
04/12/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,750 0001613919058 1901056106750006
1196
SALIMUN
ISTRI
21/06/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,751 0001613919069 1901051301970003
1196
RAHMAD ADI SUGANDI
ANAK
13/01/1997
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,752 0001613919071 1901052708400001
1199
USI MAID
PESERTA
27/08/1940
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,753 0001613919082 1901054502400001
1199
FATIMAH
ISTRI
05/02/1940
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,754 0001613919093 1901055207990001
1199
ADE BELLA RAHDIANSYAH
ANAK
12/07/1999
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,755 0001613919104 1901055707550002
1202
SATUNAH
PESERTA
17/07/1955
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,756 0001613919115 1901056605560002
1203
MISNAH
PESERTA
26/05/1956
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,757 0001613919126 1901052304840001
1203
MUHAMMAD SAFI'I
ANAK
23/04/1984
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,758 0001613919137 1602024107340008
1205
ROHILA
PESERTA
01/07/1934
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,759 0001613919148 1602024703790001
1205
SUMIYATI
ANAK
07/03/1979
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,760 0001613919159 1602022410830001
1205
DARMAWAN
ANAK
24/10/1983
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,761 0001613919161 1901051303570002
1208
MUSRI ARPAN
PESERTA
13/03/1957
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,762 0001613919172 1901055204620002
1208
ROZILA
ISTRI
12/04/1962
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,763 0001613919183 1901055401990002
1208
ATTY KASURI
ANAK
14/01/1999
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,764 0001613919194 1901055512530001
1211
BONG KIM NYU
PESERTA
25/12/1953
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,765 0001613919205 1901050908900004
1212
ALDI SEPRIADI
PESERTA
09/08/1990
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,766 0001613919216 1901050811880003
1213
BAMBANG
PESERTA
08/11/1983
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,767 0001613919227 1901056304040002
1213
APRIYANTI
TAMBAHAN
23/04/2004
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 425 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,768 0001613919238 1901057012960004
1215
DENI VILDA
PESERTA
30/12/1996
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,769 0001613919249 1901050809010006
1215
AGONG PRATAMA
ANAK
08/09/2001
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,770 0001613919251 1901054203540002
1217
TJOK MOEK FEW
PESERTA
02/03/1954
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,771 0001613919262 1901051303520001
1218
LIM DJUN THIN
PESERTA
13/03/1952
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,772 0001613919273 1901056203570001
1218
TJOE SOEN TJUAN
ISTRI
22/03/1957
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,773 0001613919284 1901050501680002
1220
ROSDI
PESERTA
05/01/1968
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,774 0001613919295 1901055809980001
1220
MARDA TILA YELDI
ANAK
18/09/1998
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,775 0001613919306 1901055402480001
1222
TJHIN SIN KIW
PESERTA
14/02/1948
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,776 0001613919317 1901056102550001
1222
LINDA FITRIA TJEN
ISTRI
21/02/1955
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,777 0001613919328 1901051208720002
1224
SLAMET
PESERTA
12/08/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,778 0001613919339 1901054405770002
1224
ERLAN
ISTRI
04/05/1977
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,779 0001613919341 1901054601090002
1224
DELLA AFINIYA
ANAK
06/01/2009
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,780 0001613919352 1901050609800001
1227
PINANTUN PAKPAHAN
PESERTA
06/09/1980
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,781 0001613919363 1901056212800001
1227
RIDNA GARWAWATI
ISTRI
22/12/1980
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,782 0001613919374 1901055403040001
1227
FIORENTINA
ANAK
14/03/2004
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,783 0001613919385 1901054304090001
1227
SUCI AULIA
ANAK
03/04/2009
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,784 0001613919396 1901051011630002
1231
RIFAAT
PESERTA
10/11/1953
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,785 0001613919407 1901055507510001
1232
ASMANA
PESERTA
15/07/1951
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,786 0001613919418 1901050206830004
1232
MADI
ANAK
02/06/1983
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,787 0001613919429 1901051802620001
1234
ROSIDI
PESERTA
18/02/1962
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,788 0001613919431 1901056107720003
1235
DARMA
PESERTA
21/07/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,789 0001613919442 1901050505060003
1235
IQBAL RISWANTA
ANAK
05/05/2006
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,790 0001613919453 1901051710830004
1237
SAHRIL
PESERTA
17/10/1983
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 426 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,791 0001613919464 1901050405730002
1238
AZWAR
PESERTA
04/05/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,792 0001613919475 1901057008790002
1238
SAIDAH
ISTRI
30/08/1979
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,793 0001613919486 1901051409030002
1238
MUHAMAD ADJI SAIWA AZMY
ANAK
14/09/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,794 0001613919497 1901061808670001
1241
JUMADI
PESERTA
18/08/1967
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,795 0001613919508 1901064107670034
1241
SAKDIAH
ISTRI
01/07/1967
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,796 0001613919519 1901061712910001
1241
PREDI
ANAK
17/12/1991
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,797 0001613919521 1901051409970001
1241
ARDIYANTO
ANAK
14/09/1997
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,798 0001613919532 1901064705050001
1241
YANTI
ANAK
07/05/2005
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,799 0001613919543 1901051905630002
1246
ABU BAKAR
PESERTA
19/05/1963
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,800 0001613919554 1901057009830002
1246
SURIAH
ISTRI
30/09/1963
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,801 0001613919565 1901055405950004
1246
YUNITA
ANAK
14/05/1995
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,802 0001613919576 1901055610980002
1246
RISMA
ANAK
16/10/1998
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,803 0001613919587 1901060506770001
1250
AHMAD FAJRI
PESERTA
05/05/1977
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,804 0001613919598 1901065507810002
1250
ANIDA
ISTRI
15/07/1981
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,805 0001613919609 1901061112990001
1250
MOH.TAUFIK
ANAK
11/12/1999
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,806 0001613919611 1901065305040001
1250
ANAJUAN SALSABILA
ANAK
13/05/2004
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,807 0001613919622 1901062008100001
1250
ALI MUZAIN
ANAK
20/08/2010
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,808 0001613919633 1901050107570022
1255
MANSURI
PESERTA
01/07/1957
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,809 0001613919644 1901054106630001
1255
SINA
ISTRI
01/06/1963
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,810 0001613919655 1901050711860001
1255
ROMANSYAH
ANAK
07/11/1986
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,811 0001613919666 1901052711900004
1255
MULYADI
ANAK
27/11/1990
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,812 0001613919677 1901052712970003
1255
UNTUNG LESMANA
ANAK
27/12/1997
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,813 0001613919688 1901050804740003
1260
SARMILI
PESERTA
06/04/1974
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 427 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,814 0001613919699 1901051803550001
1261
SUARIN
PESERTA
18/03/1955
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,815 0001613919701 1901054604610001
1261
BIARTI
ISTRI
06/04/1961
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,816 0001613919712 1901050604840001
1261
BURHANUDIN
ANAK
06/04/1984
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,817 0001613919723 1901056110890001
1261
SUDINAWATI
ANAK
21/10/1989
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,818 0001613919734 1901051305820001
1265
RAHMAT
PESERTA
13/05/1982
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,819 0001613919745 1901055103910001
1265
IGRA NURHAYANI
ISTRI
28/03/1991
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,820 0001613919756 1901051306110002
1265
FAIZ AQILAH
ANAK
13/06/2011
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,821 0001613919767 1901052708140001
1265
FADRIL ALIF
ANAK
27/08/2014
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,822 0001613919778 1901055612670001
1269
AMSAH
PESERTA
16/12/1987
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,823 0001613919789 1901050104940001
1269
RIZQY ROHUSAR
ANAK
04/04/1994
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,824 0001613919791 1901054607990001
1269
PUJA SETIA
ANAK
16/07/1999
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,825 0001613919802 1901056309020001
1269
DEDES WIDARNA
ANAK
23/09/2002
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,826 0001613919813 1901052303790003
1273
ANNAHWA
PESERTA
23/03/1979
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,827 0001613919824 1901050103860004
1273
TABRONI
ANAK
01/03/1986
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,828 0001613919835 1901051506560002
1275
MAWARD LUBIS
PESERTA
15/06/1956
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,829 0001613919846 1901055708590001
1275
SALMIAH
ISTRI
17/08/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,830 0001613919857 1901054209970004
1275
GUSTINA LUBIS
ANAK
02/09/1997
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,831 0001613919868 1901052006790001
1278
AMRAN
PESERTA
20/06/1979
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,832 0001613919879 1901050210000003
1278
AMI YOGA
ANAK
02/10/2000
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,833 0001613919881 1901054401030002
1278
YULISTIA ZULFI SABELLA
ANAK
04/01/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,834 0001613919892 1901056305120003
1278
AURA KHALILA RADISTI
ANAK
23/05/2012
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,835 0001613919903 1901050107890010
1282
RAHMAT
PESERTA
20/04/1989
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,836 0001613919914 1901055505910001
1282
DEVIA
ISTRI
15/05/1991
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 428 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,837 0001613919925 1901054512120001
1282
RIRIN DELVIANA
ANAK
05/12/2012
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,838 0001613919936 1901052204870003
1285
ALI BUANG
PESERTA
22/04/1987
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,839 0001613919947 1901056608640001
1286
ZURIAH
PESERTA
26/08/1964
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,840 0001613919958 1901050804860001
1286
ZULKARYA
ANAK
08/04/1986
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,841 0001613919969 1901052501900001
1286
JAKA ZULPIKAR
ANAK
25/01/1990
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,842 0001613919971 1901054104010001
1286
ZAKIA AMALIA PUTRI
ANAK
01/04/2001
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,843 0001613919982 1901050112700001
1290
DAMRI JULIO RISGANDI
PESERTA
01/12/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,844 0001613919993 1901056207710001
1290
HABIBAH
ISTRI
22/07/1971
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,845 0001613920004 1901053010020002
1290
HERVINSA ALQORNI
ANAK
30/10/2002
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,846 0001613920015 1901050101080001
1290
MUHAMAD VICO DWI

PANGGARA
ANAK
01/01/2008
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,847 0001613920026 1901052602550001
1294
ALADIN
PESERTA
26/02/1955
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,848 0001613920037 1901055604580002
1294
MINAH
ISTRI
16/04/1958
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,849 0001613920048 1901056401900002
1294
ATIK
ANAK
24/01/1990
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,850 0001613920059 1901053009700003
1297
MARYADI
PESERTA
30/09/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,851 0001613920061 1901056410760002
1297
ZAINAB
ISTRI
24/10/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,852 0001613920072 1901055911980002
1297
MUTIARI ZAMI
ANAK
19/11/1998
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,853 0001613920083 1901051708700003
1300
SUHERMAN
PESERTA
17/09/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,854 0001613920094 1901054509750001
1300
ARSUNA
ISTRI
05/09/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,855 0001613920105 1901055408970002
1300
SURYANTI
ANAK
14/08/1997
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,856 0001613920116 1901050509050001
1300
SUMARDI
ANAK
05/09/2005
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,857 0001613920127 1901050808720001
1304
MARWAN
PESERTA
08/08/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,858 0001613920138 1901055603750002
1304
RINAU
ISTRI
16/03/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,859 0001613920149 1901053001920001
1304
SAPARIAN
ANAK
30/01/1992
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 429 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,860 0001613920151 1901051209990003
1304
RIPAN SAPUTRA
ANAK
12/09/1999
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,861 0001613920162 1901051712020001
1304
REGI PRATAMA
ANAK
17/12/2002
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,862 0001613920173 1901054307110002
1304
PARSA AULA SARI
ANAK
03/07/2011
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,863 0001613920184 1901061010760001
1310
SYAIDINA AKASAH
PESERTA
10/10/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,864 0001613920195 1901061510790002
1310
SITI AL KHOYRAYYAROH
ISTRI
15/10/1979
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,865 0001613920206 1901062901110002
1310
FAJRI KHOSYADIL ADZAM
ANAK
29/01/2011
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,866 0001613920217 1901062008130002
1310
FATIR AL ABSI ALAM
ANAK
20/08/2013
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,867 0001613920228 1901051406730003
1314
MARDIANTO
PESERTA
14/06/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,868 0001613920239 1901055505790002
1314
SITI ROHMAH
ISTRI
15/05/1979
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,869 0001613920241 1901056205020001
1314
REKA APTANIA
ANAK
22/05/2002
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,870 0001613920252 1901050609080001
1314
MIFTAH MUZAPIR
ANAK
06/09/2008
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,871 0001613920263 1901051808580001
1318
AMRI WIJAYA
PESERTA
18/08/1958
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,872 0001613920274 1901056711610001
1318
MAHANI
ISTRI
27/12/1961
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,873 0001613920285 1901053112530002
1320
SUNANDI
PESERTA
31/12/1953
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,874 0001613920296 1901054112630001
1320
NORYAH
ISTRI
01/12/1963
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,875 0001613920307 1901053110020001
1320
ARIS AL ZIKRAN
ANAK
31/10/2002
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,876 0001613920318 1901052607540002
1323
JUNAIDI
PESERTA
26/07/1954
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,877 0001613920329 1901055310560001
1323
SAUNI
ISTRI
13/10/1956
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,878 0001613920331 1901051802830004
1325
ROBET
PESERTA
18/02/1963
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,879 0001613920342 1901054604930001
1325
LARA APRIANI
ISTRI
06/04/1993
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,880 0001613920353 1901054807110001
1325
RHADIS JULIANA
ANAK
08/07/2011
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,881 0001613920364 1901050808650001
1328
JAMHIR
PESERTA
08/08/1953
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,882 0001613920375 1901054704560001
1328
MISAH
ISTRI
07/04/1956
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 430 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,883 0001613920386 1901057006890001
1328
SOHPIATI
ANAK
05/09/1989
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,884 0001613920397 1901052910560001
1331
SUPANDI
PESERTA
29/10/1956
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,885 0001613920408 1901054107530015
1331
SOLBIYAH
ISTRI
01/07/1958
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,886 0001613920419 1901051902760002
1333
MAHMUD
PESERTA
19/02/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,887 0001613920421 1901056107760001
1333
RUSMINA
ISTRI
21/07/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,888 0001613920432 1901051512980001
1333
BAHRUL ULUM
ANAK
15/12/1998
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,889 0001613920443 1901055111020001
1333
EKA NUR FHADILAH
ANAK
11/11/2002
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,890 0001613920454 1901054711060002
1333
SITI NUR ZAKIAH
ANAK
07/11/2006
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,891 0001613920465 1901052002100001
1333
FARUK ZAKI
ANAK
20/02/2010
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,892 0001613920476 1901051103690001
1339
MARYO
PESERTA
11/03/1969
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,893 0001613920487 1901054107680008
1339
JUNA
ISTRI
10/05/1969
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,894 0001613920498 1901054107940006
1339
KEM PRIANTO
ANAK
13/05/1994
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,895 0001613920509 1901050107970006
1339
MARLINA NUR UTAMI
ANAK
10/08/1997
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,896 0001613920511 1901054107000011
1339
MANISAH KRIS JAYANTI
ANAK
01/07/2000
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,897 0001613920522 1607052019140950
1345
YAHYA KI'IN
PESERTA
31/12/1942
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,898 0001613920533 1901055004700003
1345
SUPATMI
ISTRI
10/04/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,899 0001613920544 1901057112480002
1346
SAERAH
PESERTA
31/12/1948
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,900 0001613920555 1901051707730003
1347
JONI ARIF
PESERTA
17/07/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,901 0001613920566 1901056203710001
1347
SAUNAH
ISTRI
22/03/1971
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,902 0001613920577 1901051212800010
1349
SUDARWIN
PESERTA
12/12/1980
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,903 0001613920588 1901052001690002
1350
ILHAM
PESERTA
20/01/1969
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,904 0001613920599 1901055506730002
1350
WIWIK
ISTRI
15/06/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,905 0001613920601 1901050201670001
1352
MARSONO
PESERTA
02/01/1967
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 431 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,906 0001613920612 1901055610700001
1352
IDA ROSNANI
ISTRI
16/10/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,907 0001613920623 1901051303480004
1354
WASTUM
PESERTA
13/03/1948
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,908 0001613920634 1901056606900002
1355
MARLENI
PESERTA
26/06/1990
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,909 0001613920645 1901053112670004
1356
EDI
PESERTA
31/12/1967
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,910 0001613920656 1901054107710015
1356
MARUYAH
ISTRI
01/07/1971
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,911 0001613920667 1901080107650013
1358
SUYONO
PESERTA
01/07/1965
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,912 0001613920678 1901054107720019
1358
MUJIATI
ISTRI
01/07/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,913 0001613920689 1901052207750003
1360
AIDI ALAMSYAH
PESERTA
22/07/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,914 0001613920691 1901050506660001
1361
RUSTAM
PESERTA
05/06/1966
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,915 0001613920702 1901053008870001
1362
EDI SUROSO
PESERTA
30/08/1987
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,916 0001613920713 1901056501890002
1362
ASTUTIK
ISTRI
25/01/1989
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,917 0001613920724 1901050107760016
1364
SUMIDI
PESERTA
01/07/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,918 0001613920735 1901056005730001
1365
PURWANTI
PESERTA
20/09/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,919 0001613920746 1901051108760001
1366
SUPENO
PESERTA
11/08/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,920 0001613920757 1901055708850004
1366
NURHAYATI
ANAK
17/08/1985
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,921 0001613920768 1505020405500001
1368
YAMAN
PESERTA
04/05/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,922 0001613920779 1901053112460006
1369
SUKIDI
PESERTA
31/12/1948
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,923 0001613920781 1901057112570002
1369
SINEM
ISTRI
31/12/1957
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,924 0001613920792 1901052508870002
1371
SODIKIN
PESERTA
25/08/1987
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,925 0001613920803 1901056707420001
1372
BESTIANA/BESTIANA
NAPITIPULU
PESERTA
27/07/1942
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,926 0001613920814 1901050107480010
1373
M. RONI
PESERTA
01/07/1948
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,927 0001613920825 1901051207620003
1374
NAPIA
PESERTA
12/07/1962
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,928 0001613920836 1901050504590002
1375
BASRI
PESERTA
05/04/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 432 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,929 0001613920847 1901052408030003
1376
SYAHRUL FADLI
PESERTA
24/08/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,930 0001613920858 1901055310070001
1377
NURSYIFA FAUZIAH
PESERTA
13/10/2007
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,931 0001613920869 1901062607140001
1378
MUHAMAD AL VAN GAAL
PESERTA
25/07/2014
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,932 0001613920871 1901050509810010
1379
KURNADI
PESERTA
05/09/1981
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,933 0001613920882 1901053112610002
1380
YADI
PESERTA
31/12/1961
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,934 0001613920893 1901055210620001
1380
ARMA
ISTRI
12/10/1962
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,935 0001613920904 1901051412780001
1382
SUMARTIN
PESERTA
14/12/1978
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,936 0001613920915 1901054103810002
1382
ANA MARIANA
ISTRI
01/03/1981
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,937 0001613920926 1901051811710001
1384
SAKIM SETIAWAN
PESERTA
18/11/1971
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,938 0001613920937 1901055311840003
1384
ANITA
ISTRI
13/11/1984
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,939 0001613920948 1901051003040003
1384
ABDUL AZZIS
ANAK
10/03/2004
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,940 0001613920959 1901055306080001
1384
ZISKA AMELIA
ANAK
13/06/2008
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,941 0001613920961 1901051610100001
1384
DIAN ALMAHRI
ANAK
16/10/2010
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,942 0001613920972 1901050304760001
1389
JUPRI
PESERTA
03/04/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,943 0001613920983 1901054612840002
1389
HOSMI
ISTRI
06/12/1984
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,944 0001613920994 1901054703030003
1389
SINDI FITRIANA
ANAK
07/03/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,945 0001613921005 1901050910080002
1389
RAMAD PRIYANSAH
ANAK
09/10/2008
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,946 0001613921016 1901051902930001
1393
ARI GUSTIONO
PESERTA
18/02/1993
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,947 0001613921027 1901026112920002
1393
HESTI
ISTRI
21/12/1992
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,948 0001613921038 1901057001212003
1393
CECILIA
ANAK
30/12/2012
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,949 0001613921049 1901052011670002
1396
EFFENDI HUSEIN
PESERTA
20/11/1967
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,950 0001613921051 1901051507050001
1396
NURUL HASAN
ANAK
15/07/2005
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,951 0001613921062 1905020711900001
1398
ROISMAN CAHYONO
PESERTA
07/11/1990
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 433 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,952 0001613921073 1901055412940001
1398
NURHAYATI
ISTRI
14/12/1994
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,953 0001613921084 1901056911120003
1398
NOVIKA RIZKYA RASTI
ANAK
28/11/2012
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,954 0001613921095 1901010301910003
1401
JANUAR
PESERTA
03/01/1991
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,955 0001613921106 1901017001910003
1401
ROSIELVITA SARI
ISTRI
30/01/1991
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,956 0001613921117 1901015707100003
1401
BILQIS SALSABILA
ANAK
17/07/2010
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,957 0001613921128 1901011403120002
1401
KEVIN JEVITO
ANAK
14/03/2012
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,958 0001613921139 1901011707740002
1405
ARIS
PESERTA
17/07/1974
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,959 0001613921141 1901014909870008
1405
SIPURNAWATI
ISTRI
09/09/1987
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,960 0001613921152 1901016009070001
1405
WULAN SAFITRI
ANAK
20/09/2007
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,961 0001613921163 1901066512130002
1405
JESY NATALY
ANAK
25/12/2013
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,962 0001613921174 1901025108810003
1409
SUHRIYANI
PESERTA
11/08/1981
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,963 0001613921185 1901025406030001
1409
SHABILA MALIA ANANTA
ANAK
14/06/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,964 0001613921196 1901025010100002
1409
YASMIN ALEXA QUEN
ANAK
10/10/2010
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,965 0001613921207 1902070703720005
1412
PARMIN
PESERTA
07/03/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,966 0001613921218 1902077112730003
1412
SRI PRIHATI
ISTRI
31/12/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,967 0001613921229 1902076611990007
1412
NOVITA EKA PUTRI
ANAK
26/11/1999
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,968 0001613921231 1902072202020013
1412
DIMAS WIYOGA
ANAK
22/02/2002
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,969 0001613921242 1901055803100001
1412
LARASSATI DEWI NINGRUM
ANAK
28/03/2010
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,970 0001613921253 1901053107620001
1417
MAIDY
PESERTA
31/07/1962
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,971 0001613921264 1901056309640001
1417
SANTI
ISTRI
23/09/1964
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,972 0001613921275 1901051102730001
1419
SAKIMIN
PESERTA
11/02/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,973 0001613921286 1901056404730002
1419
SUHARNI
ISTRI
24/04/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,974 0001613921297 1901056801980001
1419
FITRIYANTI
ANAK
28/01/1998
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 434 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,975 0001613921308 1901052804820001
1422
ANANG SAPUTRA
PESERTA
28/04/1982
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,976 0001613921319 1901054112900003
1422
DESI
ISTRI
01/12/1990
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,977 0001613921321 1901050109090001
1422
FAJAR RAMADHAN
ANAK
01/09/2009
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,978 0001613921332 1901056310130001
1422
FIRNA ANGRAINI
ANAK
23/10/2013
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,979 0001613921343 1901050409810008
1426
HENDRI SIREGAR
PESERTA
04/09/1981
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,980 0001613921354 1901050107590016
1427
SAMIJAN
PESERTA
01/07/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,981 0001613921365 1901052812850001
1427
HARYANTO
ANAK
28/12/1985
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,982 0001613921376 1901050912870001
1427
KOLAMIN
TAMBAHAN
09/12/1987
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,983 0001613921387 1901052912900002
1427
KURNIADI
TAMBAHAN
29/12/1990
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,984 0001613921398 1901051402670001
1431
SYAMSUDIN
PESERTA
14/02/1967
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,985 0001613921409 1901056402760001
1431
HARYANI
ISTRI
14/02/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,986 0001613921411 1901052010540003
1433
SOPYAN
PESERTA
20/10/1954
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,987 0001613921422 1901015650149001
1434
ROHANA
PESERTA
25/01/1949
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,988 0001613921433 1901052108340001
1435
NASIR
PESERTA
21/08/1934
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,989 0001613921444 1901051805660001
1436
SAMSIDI
PESERTA
18/05/1966
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,990 0001613921455 1901052905550001
1437
RAHMAN
PESERTA
29/05/1955
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,991 0001613921466 1901054212610002
1437
ASIAH
ISTRI
02/12/1961
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,992 0001613921477 1901011502680001
1439
SUDIONO
PESERTA
15/02/1968
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,993 0001613921488 1901014708680002
1439
SAURAH
ISTRI
07/08/1968
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,994 0001613921499 1901051210560003
1441
MAIL
PESERTA
12/10/1956
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,995 0001613921501 1901054707760002
1441
ALIYAH
ISTRI
07/07/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,996 0001613921512 1901051502590003
1443
SUPARMAN BASRI
PESERTA
15/02/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,997 0001613921523 1901054711610001
1443
ARBIA
ISTRI
07/11/1961
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 435 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
9,998 0001613921534 1901074609680001
1445
SARMINI
PESERTA
06/09/1968
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
9,999 0001613921545 1901075612040001
1445
ROZA ASTARINA
ANAK
16/12/2004
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,000 0001613921556 1901055504520002
1447
HUMSIAH
PESERTA
15/05/1952
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,001 0001613921567 1901051106610001
1448
SAIBI UMAR
PESERTA
11/06/1961
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,002 0001613921578 1901054107580010
1449
NORIYA
PESERTA
01/07/1958
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,003 0001613921589 1901052710590002
1450
KACUP
PESERTA
27/10/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,004 0001613921591 1901052303460001
1451
HASAN
PESERTA
23/03/1946
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,005 0001613921602 1901054405450001
1451
ROPIAH
ISTRI
04/05/1945
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,006 0001613921613 1901050101720004
1453
HERMAN
PESERTA
01/01/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,007 0001613921624 1901055512440001
1454
AMI
PESERTA
15/12/1944
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,008 0001613921635 1901540108350002
1455
ACEK
PESERTA
01/08/1935
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,009 0001613921646 1901051006660002
1456
BUDIMAN
PESERTA
10/06/1966
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,010 0001613921657 1901055101690001
1456
ARNI
ISTRI
11/01/1969
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,011 0001613921668 1901050303700001
1458
MULYADI
PESERTA
03/03/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,012 0001613921679 1901055003770001
1458
SURYANI
ISTRI
10/10/1977
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,013 0001613921681 1901050601120002
1458
MURSYIDAN GHOLY
ANAK
06/01/2012
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,014 0001613921692 1901050101700002
1461
HERMAN
PESERTA
01/01/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,015 0001613921703 1901055509690002
1461
ASMAWATI
ISTRI
15/09/1969
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,016 0001613921714 1901052012650002
1463
MASYARIF
PESERTA
20/12/1965
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,017 0001613921725 1901054711670003
1463
ARPAH
ISTRI
07/11/1967
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,018 0001613921736 1901051209940001
1465
SYAHDAN
PESERTA
12/09/1994
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,019 0001613921747 1901050911010001
1466
RAJUWAN AL FIQI
PESERTA
09/11/2001
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,020 0001613921758 1901054608060002
1466
NUR SYAHLA AGUSTI
ANAK
06/08/2006
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 436 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,021 0001613921769 1901051010400001
1468
TUIN
PESERTA
10/10/1940
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,022 0001613921771 1901054606530001
1469
ASIA
PESERTA
06/06/1953
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,023 0001613921782 1901055706600003
1470
GUSTINA
PESERTA
17/08/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,024 0001613921793 1901057112670003
1471
MAHANA
PESERTA
31/12/1967
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,025 0001613921804 1901053112410002
1472
KARIM
PESERTA
13/12/1941
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,026 0001613921815 1901054507850001
1473
JULITA
PESERTA
05/07/1985
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,027 0001613921826 1901055702120001
1473
SIRA ANANDA
ANAK
17/02/2012
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,028 0001613921837 1901052008750004
1475
JUADI
PESERTA
20/08/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,029 0001613921848 1901052209580002
1476
SAIDAR
PESERTA
22/09/1958
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,030 0001613921859 1901055301630001
1476
ASMIAH
ISTRI
13/01/1963
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,031 0001613921861 1901055210450002
1478
SUDARMIN
PESERTA
23/03/1978
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,032 0001613921872 1901051704500002
1479
H. MOH. AMIN
PESERTA
17/04/1950
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,033 0001613921883 1901051802681001
1480
KOMARUDIN
PESERTA
18/02/1981
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,034 0001613921894 1901540504780003
1480
SURAIDAH
ISTRI
05/04/1978
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,035 0001613921905 1901055212620002
1482
LEMBAI
PESERTA
12/12/1962
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,036 0001613921916 1901051010620005
1483
SUKARMIN
PESERTA
10/10/1962
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,037 0001613921927 1901054905730002
1483
NURSANAH
ISTRI
09/05/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,038 0001613921938 1901056501380001
1485
TUMINAH
PESERTA
25/01/1938
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,039 0001613921949 1901050808860004
1486
SUSANTO
PESERTA
08/08/1986
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,040 0001613921951 1901054911870001
1486
SUTIA
ISTRI
09/11/1987
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,041 0001613921962 1901052407730001
1488
SUADI
PESERTA
24/07/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,042 0001613921973 1901054402800002
1488
SANIK
ISTRI
04/02/1980
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,043 0001613921984 1901054205620001
1490
HOLINUN
PESERTA
02/05/1962
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 437 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,044 0001613921995 1901056106320001
1491
MIYUK
PESERTA
08/10/1947
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,045 0001613922006 1901050406620002
1492
SAMSURI
PESERTA
04/06/1962
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,046 0001613922017 1901052104720002
1493
BAIJURI
PESERTA
21/04/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,047 0001613922028 1901055705730002
1493
SUMARNI
ISTRI
17/05/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,048 0001613922039 1901055311960003
1493
SRI RAHAYU
ANAK
13/11/1996
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,049 0001613922041 1901050701990002
1493
MUHAMMAD RAMDANI
ANAK
07/01/1999
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,050 0001613922052 1901050409020003
1493
MUHAMMAD ALDIANSYAH
ANAK
04/09/2002
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,051 0001613922063 1901054702080001
1493
SITI NURJANAH
ANAK
07/02/2008
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,052 0001613922074 1901051001950001
1499
MUHAMMAD SANDI
PESERTA
10/01/1995
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,053 0001613922085 1901057010960002
1499
YULIA SARI
ISTRI
30/10/1995
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,054 0001613922096 1905050212800001
1501
RUBI
PESERTA
02/12/1980
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,055 0001613922107 1901054507940005
1501
NURIYA
ISTRI
05/07/1994
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,056 0001613922118 1901051212810003
1503
SABAR
PESERTA
12/12/1981
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,057 0001613922129 1901050201490001
1504
SAMSURI
PESERTA
02/01/1949
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,058 0001613922131 1901054710590001
1504
SAMSIAH
ISTRI
07/10/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,059 0001613922142 1901054608690001
1506
AIDA
PESERTA
08/08/1969
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,060 0001613922153 1901051004660001
1507
SUBUR HANDI
PESERTA
10/04/1966
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,061 0001613922164 1901056608770002
1507
WARTATI
ISTRI
20/08/1977
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,062 0001613922175 1901060205770002
1509
SURUT ANZI
PESERTA
02/05/1977
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,063 0001613922186 1901055710820002
1509
NURFIA
ISTRI
17/10/1982
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,064 0001613922197 1901055611050001
1509
DEA PURNAMASARI
ANAK
16/11/2005
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,065 0001613922208 1901051503130001
1509
AHMAD MAULANA
ANAK
15/03/2013
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,066 0001613922219 1901050306550001
1513
MUSTAPA
PESERTA
03/06/1955
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 438 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,067 0001613922221 1901055209590003
1513
MARYATI
ISTRI
12/09/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,068 0001613922232 1901051112750001
1515
RAKIMAN
PESERTA
11/12/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,069 0001613922243 1901056802780002
1515
TASNITA
ISTRI
28/02/1978
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,070 0001613922254 1901050205590001
1517
AKUP
PESERTA
02/05/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,071 0001613922265 1901054808660002
1517
MASTINA
ISTRI
08/08/1966
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,072 0001613922276 1901056403930001
1517
HELA SASMITA
ANAK
24/03/1993
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,073 0001613922287 1901051708710002
1520
AGUSTIN
PESERTA
17/08/1971
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,074 0001613922298 1901054504780004
1520
HASUMI
ISTRI
05/04/1978
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,075 0001810279001 1901056110980001
1520
RIRIN OKTAVIA
ANAK
21/10/1998
PEMALI
01/05/2015
AKTIF
19,225
08/01/2015
10,076 0001613922309 1901051211650002
1522
ASHAL
PESERTA
12/11/1965
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,077 0001613922311 1901054609540002
1523
AMBIA
PESERTA
06/09/1954
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,078 0001613922322 1901052408450001
1524
SAINAH
PESERTA
24/08/1945
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,079 0001613922333 1901055502480001
1524
ROMLAH
ISTRI
15/02/1948
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,080 0001613922344 1901052605550002
1526
SYAMSIAR
PESERTA
26/05/1955
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,081 0001613922355 1901051205740001
1527
MAD NADIN
PESERTA
12/05/1974
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,082 0001613922366 1901051102760002
1528
YANTO
PESERTA
11/02/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,083 0001613922377 1901054209790001
1528
SENIWATI
ISTRI
02/09/1979
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,084 0001613922388 1901051506380001
1530
DURAM
PESERTA
15/06/1958
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,085 0001613922399 1901050305590006
1531
SALIDIN
PESERTA
03/05/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,086 0001613922401 1901060809740001
1532
YUSMAR
PESERTA
08/09/1974
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,087 0001613922412 1901064305820003
1532
KARMILA
ISTRI
05/02/1982
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,088 0001613922423 1901050703580003
1534
MUNAWAR
PESERTA
07/03/1958
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,089 0001613922434 1901054203620003
1534
MUNARAH
ISTRI
02/03/1962
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 439 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,090 0001613922445 1901050510460001
1536
H. SARIKIN
PESERTA
05/10/1946
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,091 0001613922456 1901054802480001
1536
HJ. MARSUA
ISTRI
08/02/1948
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,092 0001613922467 1901050604680001
1538
MATNARI
PESERTA
06/04/1968
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,093 0001613922478 1901050211670001
1539
ABDULLAH
PESERTA
02/11/1967
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,094 0001613922489 1901051102580001
1540
MARSUKI
PESERTA
11/02/1958
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,095 0001613922491 1901050510630001
1541
KARDIMAN
PESERTA
05/10/1963
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,096 0001613922502 1901055203740002
1541
SAMSIAH
ISTRI
12/03/1974
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,097 0001613922513 1901055210670001
1543
NARIYE
PESERTA
12/10/1967
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,098 0001613922524 1901052602600002
1544
ABDUL ASYIK
PESERTA
26/02/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,099 0001613922535 1901054107680013
1544
AMINA
ISTRI
01/07/1968
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,100 0001613922546 1901050809450001
1546
H. CONGKENEK
PESERTA
08/09/1945
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,101 0001613922557 1901050502690001
1547
ROHEMAN
PESERTA
05/02/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,102 0001613922568 1901050405670002
1548
MISJAN
PESERTA
04/05/1967
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,103 0001613922579 1901051803840003
1549
HASAN
PESERTA
18/03/1984
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,104 0001613922581 1901052004780001
1550
MUHAMMAD
PESERTA
20/04/1978
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,105 0001613922592 1901055608800001
1550
SUHARTINI
ISTRI
18/08/1980
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,106 0001613922603 1901053010790003
1552
SUPARMAN
PESERTA
30/10/1979
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,107 0001613922614 1901050505800004
1553
ROZALI
PESERTA
05/05/1980
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,108 0001613922625 1901050711660002
1554
SISWANTO
PESERTA
07/11/1966
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,109 0001613922636 1901054104760001
1554
YANI
ISTRI
01/04/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,110 0001613922647 1901052510780001
1556
SUDARMAN
PESERTA
25/10/1978
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,111 0001613922658 1901050703750001
1557
SAMSUDIN
PESERTA
07/03/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,112 0001613922669 1901050910670001
1558
SYAMSUL BIN ABU MANSYUR PESERTA
09/10/1967
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 440 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,113 0001613922671 1901054311730001
1558
SURYANI
ISTRI
03/11/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,114 0001613922682 1901050203411000
1560
ABDUL MUIS
PESERTA
02/03/1941
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,115 0001613922693 1901050507580003
1561
RAMLAN
PESERTA
05/07/1958
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,116 0001613922704 1901052707680002
1562
SUHARDIN
PESERTA
27/07/1968
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,117 0001613922715 1901055712710002
1562
MISMA MURNIYATI
ISTRI
17/12/1971
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,118 0001613922726 1901050809680002
1564
SASTRA
PESERTA
08/09/1968
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,119 0001613922737 1901054602760004
1564
FARIDA
ISTRI
06/02/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,120 0001613922748 1901061112690002
1566
DADANG
PESERTA
11/12/1969
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,121 0001613922759 1901056512760002
1566
ASTINA NURSANTI
ISTRI
25/12/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,122 0001613922761 1901052010730002
1568
PEPI NURDIANSYAH
PESERTA
20/10/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,123 0001613922772 1901055209880002
1568
ZAMI
ISTRI
12/09/1988
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,124 0001613922783 1901050703710002
1570
ZUHRI ABAS
PESERTA
07/03/1971
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,125 0001613922794 1901057001730003
1570
MARLENDA
ISTRI
30/01/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,126 0001613922805 1901057008570002
1572
MARYANI
PESERTA
30/08/1958
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,127 0001613922816 1901054802560001
1573
SOPIAH
PESERTA
08/02/1986
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,128 0001613922827 1901054208530001
1574
SULASTRI
PESERTA
02/08/1953
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,129 0001613922838 1901054808560003
1575
SUMARNI
PESERTA
08/08/1956
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,130 0001613922849 1901050507740002
1576
SUNAIDI
PESERTA
05/07/1974
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,131 0001613922851 1901056505760002
1576
ELIYA
ISTRI
05/05/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,132 0001613922862 1901050101630001
1578
MUNHARDI
PESERTA
01/01/1963
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,133 0001613922873 1901055680363002
1578
SRI MULASI
ISTRI
29/03/1968
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,134 0001613922884 1901010697000001
1580
GURUTUL AIN
PESERTA
26/07/2008
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,135 0001613922895 1901054107380010
1581
TIKA AGUSTIANINGSIH
PESERTA
01/07/1938
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 441 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,136 0001613922906 1901054107620021
1582
ERNANILA
PESERTA
01/07/1962
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,137 0001613922917 1901050107630001
1583
BASRI
PESERTA
02/10/1953
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,138 0001613922928 1901054107640001
1583
ROMIDA
ISTRI
01/07/1963
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,139 0001613922939 1901052601700002
1585
MUNDIARMO
PESERTA
26/01/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,140 0001613922941 1901056201810002
1586
NENENG ERLIANSIH
PESERTA
22/01/1981
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,141 0001613922952 1901050608730003
1587
SAHRONI
PESERTA
06/08/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,142 0001613922963 1901054906780002
1587
YUNIZAR
ISTRI
09/06/1978
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,143 0001613922974 1901021411880002
1589
MARSIBA
PESERTA
14/11/1988
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,144 0001613922985 1901051405590001
1590
MASDI
PESERTA
14/05/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,145 0001613922996 1901052309930003
1590
ODI SEPTIADI
ANAK
23/09/1993
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,146 0001613923007 1901050303530001
1592
YOHANA
PESERTA
18/05/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,147 0001613923018 1901050507750003
1593
M.TARMIZI
PESERTA
05/07/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,148 0001613923029 1910054602850001
1593
MINA
ISTRI
06/02/1985
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,149 0001613923031 1901056202830001
1595
SARIPAH AINI
PESERTA
22/02/1983
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,150 0001613923042 1901050603620002
1596
JAMSIR
PESERTA
06/03/1962
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,151 0001613923053 1901055308700002
1596
SAMSIAH
ISTRI
13/08/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,152 0001613923064 1901050306530003
1598
SOPIYAN
PESERTA
03/06/1953
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,153 0001613923075 1901054112600002
1598
SURYANTI
ISTRI
01/12/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,154 0001613923086 1901050806430001
1600
MUHAMMAD
PESERTA
08/06/1943
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,155 0001613923097 1901054601550001
1600
ROPISAH
ISTRI
06/01/1955
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,156 0001613923108 1901051308540002
1602
ABU BAKAR
PESERTA
13/08/1954
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,157 0001613923119 1901056311420002
1603
HOLIJA
PESERTA
23/11/1942
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,158 0001613923121 1901055909460002
1604
PIYATI
PESERTA
19/09/1946
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 442 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,159 0001613923132 1901056001450001
1605
HATIMA
PESERTA
20/01/1945
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,160 0001613923143 1901056405440001
1606
ROHANA
PESERTA
24/05/1944
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,161 0001613923154 1901055812690001
1607
ZAINAH
PESERTA
15/12/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,162 0001613923165 1901056707690001
1608
FAUZIAH
PESERTA
17/07/1969
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,163 0001613923176 1901056402970001
1608
FANISCA LINGLINGLIANAPUTRI
ANAK
24/02/1997
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,164 0001613923187 1901056806030001
1608
VALENCIA LIANA
ANAK
28/06/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,165 0001613923198 1901056404700002
1611
AMINAH
PESERTA
24/04/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,166 0001613923209 1901050211000001
1611
DIMAS SAPUTRA
ANAK
02/11/2000
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,167 0001613923211 1901060411420001
1613
CHANG SIP MIN
PESERTA
05/09/1942
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,168 0001613923222 1901065401540001
1613
DJAUW CIN NA
ISTRI
06/02/1954
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,169 0001613923233 1901054301030001
1615
WIDIA
PESERTA
03/01/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,170 0001613923244 1901050406080001
1615
MEIDI
TAMBAHAN
04/05/2006
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,171 0001613923255 1901051501110002
1615
JEFRI
TAMBAHAN
15/01/2011
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,172 0001613923266 1901051109130001
1615
DEFTA
TAMBAHAN
11/09/2013
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,173 0001613923277 1901051212390002
1619
MURHADI BASIR
PESERTA
12/12/1939
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,174 0001613923288 1901056308680002
1620
MUSLIMAH
PESERTA
23/08/1968
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,175 0001613923299 1901056510970002
1620
NUR OKTAVIANTY NINGSIH
ANAK
25/10/1997
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,176 0001613923301 1901050407670002
1622
ALIONO
PESERTA
04/07/1967
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,177 0001613923312 1901054108750002
1622
USMALIA
ISTRI
01/08/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,178 0001613923323 1901051508000003
1622
MUHAMMAD IKHSAN
ANAK
15/08/2000
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,179 0001613923334 1901050108090001
1622
ARIEL KURNIAWAN
ANAK
01/08/2009
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,180 0001613923345 1901055910120001
1626
RAYNI PUSPA ZAHRA
PESERTA
19/10/2012
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,181 0001613923356 1901050305660003
1627
M. TORI
PESERTA
03/06/1996
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 443 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,182 0001613923367 1901054105730002
1627
HERLINA
ISTRI
01/05/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,183 0001613923378 1901051207850002
1627
HAZARI PURNAMA
ANAK
12/07/1995
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,184 0001613923389 1901056012980002
1627
RINI SYAPITRI
ANAK
20/01/1998
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,185 0001613923391 1901051807030003
1627
MUHAMMAD RIZKI
ANAK
18/07/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,186 0001613923402 1901056905120001
1632
ZALFA DWI MEYFITA
PESERTA
29/05/2012
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,187 0001613923413 1901051504390001
1633
H.M. HAZAZI USMAN
PESERTA
15/04/1939
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,188 0001613923424 1901051105760001
1633
NURMA DEWI
ISTRI
01/05/1905
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,189 0001613923435 1901052608810001
1633
MEIZIARD
ANAK
11/05/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,190 0001613923446 1901055301800002
1636
YESLI LENI
PESERTA
13/01/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,191 0001613923457 1901054201030003
1636
WIKI ARDANISA ZARIN
ANAK
02/01/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,192 0001613923468 1901050301720001
1638
HENDRA
PESERTA
03/01/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,193 0001613923479 1901054210760001
1638
NOVI
ISTRI
02/11/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,194 0001613923481 1901054411980002
1638
NOVA HINDRIYANTI
ANAK
04/11/1998
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,195 0001613923492 1901056009000001
1638
NURRIL ALYA ADIVA
ANAK
20/09/2012
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,196 0001613923503 1901054107400014
1642
SAHINUN
PESERTA
01/07/1940
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,197 0001613923514 1901054809400001
1643
NAISA
PESERTA
08/09/1940
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,198 0001613923525 1901052704780001
1644
KAU FUK
PESERTA
27/04/1978
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,199 0001613923536 1901051408030002
1645
MASIR
PESERTA
14/08/1983
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,200 0001613923547 1901054702860001
1645
NURSIYEH
ISTRI
07/02/1986
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,201 0001613923558 1901051105080001
1645
OLFRON
ANAK
15/08/2009
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,202 0001613923569 1901051302040003
1648
MUHAMMAD EGI RIVANDI
PESERTA
13/02/2004
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,203 0001613923571 1901050201980002
1649
ARFANDY FEBRY
PESERTA
02/01/1998
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,204 0001613923582 1901056512020001
1649
PUTRI SISKA WATI
ANAK
25/12/2002
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 444 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,205 0001613923593 1901052908620001
1651
TJHUN LI
PESERTA
29/08/1962
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,206 0001613923604 1901056010720001
1651
NORI
ANAK
20/10/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,207 0001613923615 1901055112840001
1653
MULYANA
PESERTA
11/12/1984
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,208 0001613923626 1901054212030001
1653
DONA AUDIA
ANAK
02/12/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,209 0001613923637 1901052508080001
1653
YUDA ANGGARA
ANAK
25/08/2008
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,210 0001613923648 1901052704800001
1656
SUPARJO
PESERTA
27/04/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,211 0001613923659 1901056112700003
1656
HANISYAH
ISTRI
21/12/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,212 0001613923661 1901055712950003
1656
DITA SUNDARI
ANAK
17/12/1995
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,213 0001613923672 1901057004740002
1659
NERTI KARTIKA S
PESERTA
30/04/1974
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,214 0001613923683 1901055810920003
1659
AYU FRANSISKA
ANAK
18/10/1992
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,215 0001613923694 1901055002960002
1659
PUTRI ANJELI
ANAK
10/02/1996
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,216 0001613923705 1901054304980002
1659
PUJA EFENI
ANAK
03/04/1998
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,217 0001613923716 1901051301060001
1659
NABIL
ANAK
13/01/2006
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,218 0001613923727 1901052611810002
1664
SUBARTA
PESERTA
26/11/1981
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,219 0001613923738 1901051106810002
1665
KIKIB HARIS
PESERTA
11/06/1981
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,220 0001613923749 1901054112830002
1665
ANSDESTIYAYU
ANAK
01/12/1993
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,221 0001613923751 1901052406840005
1667
PARDIANTO
PESERTA
24/06/1984
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,222 0001613923762 1901055407850003
1667
HELNIS MORIN
ISTRI
14/07/1985
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,223 0001613923773 1901051412060005
1667
RIZKI PRATAMA
ANAK
14/12/2006
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,224 0001613923784 1901056904240001
1667
RIVA APRILIA
ANAK
29/04/2012
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,225 0001613923795 1901050107650009
1671
SISWANTO
PESERTA
01/07/1965
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,226 0001613923806 1901054103750002
1671
HUSNAINI
ISTRI
01/03/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,227 0001613923817 1901051006980001
1671
ANDI PUTRA PRANTAMA
ANAK
10/06/1998
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 445 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,228 0001613923828 1901051109000001
1671
BEN MANDARA PUTRA
ANAK
11/09/2000
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,229 0001613923839 1901054505040004
1671
ADE RARA MIRANDA
ANAK
05/05/2004
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,230 0001613923841 1901050202700003
1676
NURFADLI
PESERTA
02/02/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,231 0001613923852 1901054110700002
1676
SARROYA
ISTRI
01/10/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,232 0001613923863 1901052507030002
1676
ABIH SANJAYA
ANAK
25/07/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,233 0001613923874 1901055108090001
1676
QIAN GUSLIZA
ANAK
11/08/2009
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,234 0001613923885 1901051408790001
1680
SARIDAN
PESERTA
14/08/1979
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,235 0001613923896 1901055405840001
1680
RATNA
ISTRI
14/05/1984
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,236 0001613923907 1901054905090001
1680
RISKA APRIYANTI
ANAK
09/05/2009
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,237 0001613923918 1901051307750002
1683
SARMILI
PESERTA
13/07/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,238 0001613923929 1901056701860008
1683
ELIYA
ISTRI
27/01/1988
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,239 0001613923931 1901050206120001
1683
JUAN AKBAR
ANAK
02/06/2012
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,240 0001613923942 1901050704720004
1686
A. ROHMAN
PESERTA
07/04/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,241 0001613923953 1901055702780001
1686
SAMIAH
ISTRI
17/02/1978
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,242 0001613923964 1901052305050002
1686
DIPTA RAMA
ANAK
23/05/2005
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,243 0001613923975 1901055309110001
1686
NADINE ZAHRA
ANAK
13/09/2011
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,244 0001613923986 1901010405830007
1690
DENI
PESERTA
04/05/1983
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,245 0001613923997 1901016002870006
1690
YENI MARTINA
ISTRI
20/02/1987
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,246 0001613924008 1901013103080003
1690
ALLFIRO MARDIANSYAH
ANAK
31/03/2008
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,247 0001613924019 1901051306520003
1693
DJUMHANA
PESERTA
13/06/1952
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,248 0001613924021 1901055405610003
1693
YUNIRNA
ISTRI
14/05/1961
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,249 0001613924032 1901055405900001
1693
SITI AIZATI
ANAK
14/05/1990
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,250 0001613924043 1901050105670001
1696
YULYADI
PESERTA
01/05/1967
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 446 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,251 0001613924054 1901054711750001
1696
HARIYATI
ISTRI
07/11/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,252 0001613924065 1901052702730002
1698
ARIP WARTONO
PESERTA
27/02/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,253 0001613924076 1901056803800001
1698
SUSILAWATI
ISTRI
28/03/1980
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,254 0001613924087 1901055104000002
1698
MELINIA ANANDA PUTRI
ANAK
11/04/2000
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,255 0001613924098 1901054501050001
1698
DIAH PUTRI KURNIA
ANAK
05/01/2005
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,256 0001613924109 1901024101000006
1702
MESSY SARASWATY SIREGAR PESERTA
01/01/2000
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,257 0001613924111 1901056708300002
1703
LAY A TJHIONG
PESERTA
27/08/1930
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,258 0001613924122 1901051604800002
1704
BONG SUI LUN
PESERTA
20/05/1953
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,259 0001613924133 1901054608550004
1705
BOEN KIN NIE
PESERTA
05/08/1955
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,260 0001613924144 1901055702930002
1706
DETA LARASSATY
PESERTA
17/02/1993
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,261 0001613924155 1901052603740001
1707
AZUAR DHANI
PESERTA
28/03/1974
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,262 0001613924166 2104014107590073
1708
HENNY ZAKIR
PESERTA
01/07/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,263 0001613924177 1901056904490002
1709
HAYUNI HJ
PESERTA
29/04/1949
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,264 0001613924188 1901056009640003
1710
HERYANA
PESERTA
20/09/1964
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,265 0001613924199 1901054702800001
1711
NUNUNG
PESERTA
07/02/1980
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,266 0001613924201 1901050109080001
1711
SURYA ROMDAN ANJANI
ANAK
01/09/2008
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,267 0001613924212 1901050201120001
1711
ARMAN
ANAK
02/01/2012
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,268 0001613924223 1901053107650002
1714
KOSIM
PESERTA
31/07/1965
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,269 0001613924234 1901056804060001
1714
NUR AZIZAH
ANAK
28/04/2006
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,270 0001613924245 1901052712120001
1714
MUHAMMAD ICHSAN
ANAK
27/12/2012
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,271 0001613924256 1901056008890004
1717
WIWIN AGUSTRIANI
PESERTA
20/06/1989
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,272 0001613924267 1901050107370017
1718
DJAMUK MININ
PESERTA
01/07/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,273 0001613924278 1901052702370002
1719
ISMAIL D
PESERTA
27/02/1937
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 447 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,274 0001613924289 1901056010420002
1719
MASKINAH
ISTRI
20/10/1942
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,275 0001613924291 1901051412390001
1721
DJHONG KHIUN PHIN
PESERTA
14/12/1939
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,276 0001613924302 3276012105430001
1722
TIMIN
PESERTA
29/07/1982
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,277 0001613924313 3276015203460006
1722
SUYANTI
ISTRI
27/11/1986
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,278 0001613924324 1901057007530001
1724
KAM NJOEK LAN
PESERTA
30/07/1953
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,279 0001613924335 1901051701800001
1724
RONNY DJAUHARI
ANAK
17/01/1980
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,280 0001613924346 1901054202600002
1726
HIE NGIAM NA
PESERTA
02/02/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,281 0001613924357 1901050510030002
1727
OKTIAN SASTRA YUDHA
PESERTA
05/10/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,282 0001613924368 1901054200410001
1728
LIE NGIM FA
PESERTA
02/03/1941
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,283 0001613924379 1901051708540001
1729
LIE SUI LOI
PESERTA
17/08/1954
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,284 0001613924381 1901056006510001
1729
PHOENG MIE LING
ISTRI
20/06/1951
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,285 0001613924392 1901056505490003
1731
LIE NYUK DJIN
PESERTA
25/05/1949
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,286 0001613924403 1901051606730001
1731
MIN FU
ANAK
16/06/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,287 0001613924414 1901051211800004
1731
MIN HIUNG
ANAK
12/11/1980
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,288 0001613924425 3313130808720003
1734
SUKIDI
PESERTA
08/08/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,289 0001613924436 3313134504760002
1734
TUMINI
ISTRI
05/04/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,290 0001613924447 3313134212960002
1734
DEWI ANDIKA SARI
ANAK
02/12/1996
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,291 0001613924458 3313131105030002
1734
DIMAS ADI SAPUTRO
ANAK
11/05/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,292 0001613924469 1901010404700001
1738
SUJIYONO
PESERTA
04/04/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,293 0001613924471 1901050204560001
1739
HARYANTO
PESERTA
02/04/1956
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,294 0001613924482 1901055610590002
1739
TJHIN LIE JIN
ISTRI
16/10/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,295 0001613924493 1901050802510001
1741
DJHAUW FEN KONG
PESERTA
08/02/1951
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,296 0001613924504 1901055006520002
1741
DJHONG KI HIONG
ISTRI
10/06/1952
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 448 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,297 0001613924515 1901054209480001
1743
TJIOE MIE LAN
PESERTA
02/09/1948
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,298 0001613924526 1901050805640001
1744
HERWAN
PESERTA
08/05/1964
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,299 0001613924537 1901057008680002
1744
WAGINAH
ISTRI
30/08/1968
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,300 0001613924548 1901050308880001
1744
RAMA
ANAK
03/08/1988
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,301 0001613924559 1901052703000002
1744
RIAN
ANAK
27/03/2000
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,302 0001613924561 1901054104040002
1744
MELI
ANAK
01/04/2004
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,303 0001613924572 1901052204060001
1744
ALDO
ANAK
22/04/2006
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,304 0001613924583 1901054306640001
1750
SUGINA
PESERTA
03/06/1964
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,305 0001613924594 1901054203990001
1750
FEBI YUSTIKA SARI
ANAK
02/03/1999
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,306 0001613924605 1901051412030002
1750
DESKAL ANDRIAN SAPUTRA
ANAK
14/12/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,307 0001613924616 1901051706910001
1753
RAHMAT ERWANDI
PESERTA
17/06/1991
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,308 0001613924627 1901052302940001
1753
ANDI KUSUMAGIRI
ANAK
23/02/1994
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,309 0001613924638 1901051512970002
1753
DARMAASMARA
ANAK
15/12/1997
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,310 0001613924649 1901056712980001
1753
YOMI MELATI
ANAK
27/12/1998
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,311 0001613924651 1901056010990006
1753
WINI NURSINTA
ANAK
20/10/1999
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,312 0001613924662 1901051210010002
1753
YOKI DARMAWAN
ANAK
12/10/2001
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,313 0001613924673 1901054705030002
1753
CERIA PERMATA
ANAK
07/05/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,314 0001613924684 1901054903050002
1753
INDAH JELITA
ANAK
09/02/2006
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,315 0001613924695 1901055610090001
1753
PARAS RUPAWAN
ANAK
16/10/2008
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,316 0001613924706 1901054405640001
1762
JUNIAR
PESERTA
04/05/1964
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,317 0001613924717 1901051201000003
1762
ARDIANSYAH
ANAK
12/01/2000
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,318 0001613924728 1901050701430002
1764
HAZIZUN
PESERTA
01/01/1945
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,319 0001613924739 1901054701440001
1764
HOLIPA
ISTRI
07/01/1944
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 449 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,320 0001613924741 1901053012680001
1764
SUHARDIN
ANAK
30/12/1969
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,321 0001613924752 1901052611800001
1764
ZULPIKAR
ANAK
25/11/1980
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,322 0001613924763 1901050306690001
1768
SUHARLI
PESERTA
03/06/1969
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,323 0001613924774 1901056104740002
1768
ARJUNA
ISTRI
21/04/1974
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,324 0001613924785 1901055406920002
1768
ANGGIA ERSINTHA
ANAK
14/06/1992
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,325 0001613924796 1901051304970002
1768
ANGKY ELANDYKA
ANAK
13/04/1997
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,326 0001613924807 1901050412450001
1772
DARYONO
PESERTA
12/04/1945
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,327 0001613924818 1901054108510001
1772
SUTINA
ISTRI
12/01/1950
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,328 0001613924829 1901050811710003
1774
NOVI EKO PURNOMO
PESERTA
08/11/1971
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,329 0001613924831 1901051407490002
1775
MURIDAN
PESERTA
14/07/1949
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,330 0001613924842 1901056708500002
1775
MAIROHANI
ISTRI
27/06/1950
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,331 0001613924853 1901051101040001
1777
PURNAMA ARBAGI
PESERTA
11/01/1984
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,332 0001613924864 1901053005900001
1777
MURSANI
ANAK
30/05/1990
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,333 0001613924875 1901051908100008
1779
MARCELUS MOA
PESERTA
05/06/1968
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,334 0001613924886 1901054106090001
1779
MARIA ROSINTA
ISTRI
01/06/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,335 0001613924897 1901054112040004
1779
MONICA ROSALINA
ANAK
01/12/2004
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,336 0001613924908 1901056606490001
1782
UMIYATI
PESERTA
26/06/1949
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,337 0001613924919 1901050611700001
1782
ANDI FAJAMI
ANAK
06/11/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,338 0001613924921 1901014703830004
1784
NURHAYATI
PESERTA
07/03/1981
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,339 0001613924932 1901016410030002
1784
IMELDA
ANAK
24/10/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,340 0001613924943 1901054701430004
1786
ROPIAH
PESERTA
10/04/1943
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,341 0001613924954 1901051507480003
1787
TJEN PIAN FONG
PESERTA
15/07/1948
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,342 0001613924965 1901054102570003
1787
TJHIN A HO
ISTRI
01/02/1957
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 450 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,343 0001613924976 1901056311860001
1787
YUDA PURNAMA
ANAK
23/11/1986
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,344 0001613924987 1901055001980002
1787
JESI WULANDARI
ANAK
10/01/1998
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,345 0001613924998 1901052401720001
1791
MUHAMMAD IRPAN
PESERTA
24/01/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,346 0001613925009 1901054911700001
1791
ERMANILA
ISTRI
09/11/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,347 0001613925011 1901055602010001
1791
RISKI AIDILIA FITRIYANI
ANAK
16/02/2001
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,348 0001613925022 1901052111030003
1791
FIRMAN ADIANSYAH
ANAK
21/11/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,349 0001613925033 1901051205070002
1791
ALLHAM ADIANSYAH
SAPUTRA
ANAK
12/06/2007
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,350 0001613925044 1901055008720002
1796
HUNAINAH
PESERTA
10/08/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,351 0001613925055 1901051503540002
1797
SIAW NAM THIAM
PESERTA
15/03/1954
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,352 0001613925066 1901054702630001
1797
TJHIN ADJIN
ISTRI
07/02/1963
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,353 0001613925077 1901054107650031
1799
NASIHA
PESERTA
01/07/1965
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,354 0001613925088 1901054111500001
1800
SIM SUI FA
PESERTA
01/11/1950
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,355 0001613925099 1901051008760001
1801
SAK JIN
PESERTA
08/10/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,356 0001613925101 1901056903770001
1801
PISENSIA
ISTRI
29/03/1977
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,357 0001613925112 1901054911070001
1801
STEFANY CLARA CLARENSIA
ANAK
11/09/2007
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,358 0001613925123 1901056109800001
1804
YULIANTI
PESERTA
21/09/1990
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,359 0001613925134 1901050208520002
1805
SARMADA
PESERTA
08/02/1952
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,360 0001613925145 1901056905600001
1805
JUMAINI
ANAK
29/05/1980
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,361 0001613925156 1901050512030002
1805
DERY SUPRIYATNA
ANAK
06/12/1983
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,362 0001613925167 1901056701590001
1808
AMINAH
PESERTA
27/01/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,363 0001613925178 1901050110870018
1808
HANDIKA SISWANTO
ANAK
01/10/1987
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,364 0001613925189 1901052107910003
1808
SOBRI EFFENDI
ANAK
21/07/1991
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,365 0001613925191 1901050208470005
1811
SAMIUN
PESERTA
02/08/1947
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 451 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,366 0001613925202 1901057112340003
1812
SANA
PESERTA
31/12/1934
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,367 0001613925213 1901055206330001
1812
SEMI
ANAK
12/06/1933
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,368 0001613925224 1901052101710003
1814
SAIBI
PESERTA
21/01/1971
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,369 0001613925235 1901051902990002
1814
PERULIAN
ANAK
19/02/1999
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,370 0001613925246 1901055810010002
1814
NURLITA
ANAK
18/10/2001
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,371 0001613925257 1901055500954003
1817
SAUNIT
PESERTA
15/09/1954
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,372 0001613925268 1901050107740014
1818
SAMSUL S
PESERTA
01/07/1974
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,373 0001613925279 1901054107790019
1818
YULIANA
ISTRI
01/07/1979
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,374 0001613925281 1901052805080002
1818
AHMAD AYUBI
ANAK
28/05/2008
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,375 0001613925292 1901024203880001
1821
AGUS SUGIANTO
PESERTA
02/03/1988
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,376 0001613925303 1901055401910003
1821
AYU AZHARI
ISTRI
14/01/1991
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,377 0001613925314 1901051407100005
1821
ALVIN JULIANDA
ANAK
04/07/2010
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,378 0001613925325 1901056710610001
1824
ROJIMA
PESERTA
27/10/1961
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,379 0001613925336 1901052601880002
1824
DODI SATRIADI
ANAK
26/01/1988
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,380 0001613925347 1901054110890001
1824
DAMAYANTI
ANAK
01/10/1989
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,381 0001613925358 1901054203700001
1827
HOMSIAH
PESERTA
02/03/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,382 0001613925369 1901051103930001
1827
AEF SUHENDRI
ANAK
11/03/1993
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,383 0001613925371 1901051912990002
1827
ANDRIYANATA
ANAK
19/12/1999
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,384 0001613925382 1901054107450023
1830
HJ.SAMIAH
PESERTA
01/07/1945
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,385 0001613925393 1901050810420001
1831
AZIZ
PESERTA
08/10/1942
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,386 0001613925404 1901054603490001
1831
YUHANI
ISTRI
06/03/1949
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,387 0001613925415 1901051907970001
1833
REZI ZULYAWAN
PESERTA
19/07/1997
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,388 0001613925426 1901060709470001
1834
ADIMAN
PESERTA
07/09/1947
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 452 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,389 0001613925437 1901051510630002
1835
SYARIPUDIN
PESERTA
15/10/1963
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,390 0001613925448 1901054908770003
1835
AGUSTIANI
ISTRI
09/08/1977
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,391 0001613925459 1901053009010002
1835
AHMAD CAISAR
ANAK
30/09/2001
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,392 0001613925461 1901056201110001
1835
KAESYA ASIFA
ANAK
22/01/2011
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,393 0001613925472 1901050905810004
1839
HENDRA WAHYUDI
PESERTA
09/05/1981
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,394 0001613925483 1901056602870002
1839
RIAH BUNDA
ISTRI
26/02/1987
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,395 0001613925494 1901056007090002
1839
DINDA SAVITRI
ANAK
20/07/2009
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,396 0001613925505 1901056303930002
1842
EKA RUSMADANI
PESERTA
23/03/1993
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,397 0001613925516 1901050112010003
1842
SUPRIYONO
ANAK
01/12/2001
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,398 0001613925527 1901054407510001
1844
SINA MATANI
PESERTA
04/07/1951
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,399 0001613925538 1901054812630003
1844
JAMIAH
ISTRI
08/12/1963
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,400 0001613925549 1901050501460002
1846
ASNAN
PESERTA
05/10/1946
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,401 0001613925551 1901055708790001
1847
SARI WATI
PESERTA
17/08/1979
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,402 0001613925562 1901050112440001
1848
DAHARI
PESERTA
01/12/1944
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,403 0001613925573 1901060810430002
1849
BADRI
PESERTA
08/10/1943
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,404 0001613925584 1901054505510002
1850
SURIA
PESERTA
05/05/1951
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,405 0001613925595 1901050503530001
1851
MUSTAR
PESERTA
05/03/1953
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,406 0001613925606 1901054506600001
1851
KARTINI
ISTRI
05/08/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,407 0001613925617 1901054107430023
1853
MASTUR
PESERTA
01/07/1943
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,408 0001613925628 1901050804510003
1854
MUSLI
PESERTA
08/04/1951
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,409 0001613925639 1901054504530004
1854
JALIAH
ISTRI
05/04/1953
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,410 0001613925641 1901056112640001
1856
MURLIS
PESERTA
21/12/1964
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,411 0001613925652 1901056712900006
1856
YURNI LISNAWATI
ANAK
27/12/1990
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 453 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,412 0001613925663 1901050107380005
1858
JAHUN AKIR
PESERTA
01/05/1930
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,413 0001613925674 1901054107480005
1858
SOLEHA
ISTRI
03/02/1948
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,414 0001613925685 1901051412660001
1860
SIDIK
PESERTA
14/12/1966
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,415 0001613925696 1901054101700003
1860
MANILA
ISTRI
01/01/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,416 0001613925707 1901051110940003
1860
HERIYANDA
ANAK
11/10/1994
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,417 0001613925718 1901055112600002
1863
YASMI
PESERTA
11/12/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,418 0001613925729 1901050107830014
1864
NASIR
PESERTA
01/07/1983
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,419 0001613925731 1901054107280004
1865
JAUYAH
PESERTA
01/01/1928
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,420 0001613925742 1901054802440002
1866
MAHANI
PESERTA
08/02/1944
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,421 0001613925753 1901051209360001
1867
ASIR
PESERTA
12/09/1936
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,422 0001613925764 1901054107430006
1867
KALOK
ISTRI
22/02/1944
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,423 0001613925775 1901054107340012
1869
MAJENAH
PESERTA
01/07/1934
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,424 0001613925786 1901050610460001
1870
YAHYA
PESERTA
06/10/1946
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,425 0001613925797 1901054107520014
1870
MARYAM
ISTRI
01/07/1952
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,426 0001613925808 1901054503450001
1872
BADI'AH
PESERTA
05/03/1945
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,427 0001613925819 1901051208830002
1872
KAMHAR
ANAK
12/08/1983
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,428 0001613925821 1901056007750002
1874
DALIYAH
PESERTA
20/07/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,429 0001613925832 1901054101010002
1874
SAFITRI
ANAK
01/01/2001
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,430 0001613925843 1901051005060001
1874
SYAFI'I ARIPIN
ANAK
10/05/2006
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,431 0001613925854 1901055306450001
1877
ARUMI
PESERTA
13/06/1945
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,432 0001613925865 1901054107570027
1878
DAHMI
PESERTA
01/07/1957
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,433 0001613925876 1901054107540025
1879
SUTIPAH
PESERTA
01/07/1954
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,434 0001613925887 1901055306340001
1880
SENAH
PESERTA
13/06/1934
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 454 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,435 0001613925898 1901052407630001
1881
SAMSUDIN
PESERTA
24/07/1963
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,436 0001613925909 1901055408550001
1881
ASMANA
ISTRI
14/08/1965
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,437 0001613925911 1901055203390001
1883
SURI
PESERTA
12/03/1938
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,438 0001613925922 1901050710740001
1884
SYAMSIAR
PESERTA
10/07/1974
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,439 0001613925933 1901055903700001
1884
AZIZA SIDIK
ISTRI
29/03/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,440 0001613925944 1901052601920003
1884
ARI SANJAYA PUTRA

PRATAMA
ANAK
26/01/1992
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,441 0001613925955 1901051005650004
1887
SOPIYAN
PESERTA
10/05/1965
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,442 0001613925966 1901054107600026
1887
MARGAYAH
ISTRI
01/07/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,443 0001613925977 1901054107530028
1889
SANA BADARUIS
PESERTA
01/07/1953
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,444 0001613925988 1901050707690005
1889
MUHAMMAD DAMLI
ANAK
07/07/1969
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,445 0001613925999 1901050107480008
1891
LAUSANI
PESERTA
01/07/1948
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,446 0001613926001 1901055108420001
1892
KALOK
PESERTA
11/08/1942
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,447 0001613926012 1901050107420006
1893
MUHAMMAD B BELO
PESERTA
01/07/1942
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,448 0001613926023 1901054107460005
1893
MINAH
ISTRI
01/07/1946
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,449 0001613926034 1901056112440001
1895
HJ.JALIAH
PESERTA
30/01/1942
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,450 0001613926045 1901055707740001
1896
ANILA
PESERTA
17/07/1974
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,451 0001613926056 1901055802960001
1896
FETY RISKA WATI
ANAK
18/02/1996
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,452 0001613926067 1901054202000002
1896
FEBY YOLLA
ANAK
02/02/2000
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,453 0001613926078 1901050307040002
1896
GERY YUDHA
ANAK
03/07/2004
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,454 0001613926089 1901051004380001
1900
ABDULLAH SANI
PESERTA
10/04/1938
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,455 0001613926091 1901054707460001
1900
AYO
ISTRI
07/07/1946
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,456 0001613926102 1901050507660001
1902
JUNAIDI
PESERTA
05/07/1966
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,457 0001613926113 1901056208720002
1902
HERNAWATI
ISTRI
22/08/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 455 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,458 0001613926124 1901050906080003
1902
YULIANSYAH
ANAK
09/06/2008
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,459 0001613926135 1901050107580018
1905
SUHUD
PESERTA
01/07/1958
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,460 0001613926146 1901054109600001
1905
SUMAINI
ISTRI
01/09/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,461 0001613926157 1901054107420023
1907
SUM
PESERTA
01/07/1942
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,462 0001613926168 1901052402600001
1908
ISROK
PESERTA
24/02/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,463 0001613926179 1901055501520005
1909
SAINUN
PESERTA
15/01/1952
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,464 0001613926181 1901055108540036
1910
SAUNI
PESERTA
08/11/1954
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,465 0001613926192 1901051607440002
1911
RUSID
PESERTA
16/07/1944
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,466 0001613926203 1901054107470007
1912
MASNI
PESERTA
01/07/1947
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,467 0001613926214 1901054107380004
1913
MAINI
PESERTA
01/07/1938
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,468 0001613926225 1901052011830006
1914
ASRONI
PESERTA
20/11/1983
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,469 0001613926236 1901054304740004
1914
MURINA
ISTRI
05/04/1974
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,470 0001613926247 1901054107110002
1914
CEERIE FATRA
ANAK
01/07/2011
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,471 0001613926258 1901054107570009
1917
TARWINA
PESERTA
01/07/1957
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,472 0001613926269 1901050107333001
1918
KOMAR
PESERTA
01/07/1933
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,473 0001613926271 1901053101810002
1919
ROBI HARUN
PESERTA
31/01/1981
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,474 0001613926282 1602026311860001
1919
SRI REJEKI
ISTRI
13/03/1987
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,475 0001613926293 1901056812120001
1919
KEYMOZA PUTRI OKIBA
ANAK
28/12/2012
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,476 0001613926304 1901052007460001
1922
KIDING
PESERTA
20/07/1946
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,477 0001613926315 1901052507840001
1922
KRISNO
ANAK
25/07/1984
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,478 0001613926326 1901052409620001
1924
MUIS
PESERTA
24/09/1962
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,479 0001613926337 1901050307740002
1925
ROBUAN
PESERTA
03/07/1974
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,480 0001613926348 1306144308750001
1925
MEMI AGUSTI
ISTRI
03/08/1975
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 456 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,481 0001886519182 1901054107380015
1925
ROHANI
TAMBAHAN
01/07/1938
PEMALI
01/05/2015
AKTIF
19,225
16/09/2015
10,482 0001613926359 1901055008510003
1927
SOLEHA
PESERTA
10/08/1951
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,483 0001613926361 1901054107730024
1927
HIJAIYAH
ANAK
01/07/1973
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,484 0001613926372 1901056007610003
1929
SITAM
PESERTA
20/07/1961
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,485 0001613926383 1901051111770005
1930
ABDUL RAHMAN
PESERTA
11/11/1977
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,486 0001613926394 1901055612800004
1930
LENNA
ISTRI
16/12/1980
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,487 0001613926405 1901052502110001
1930
ALI AKBAR FELAYATI
ANAK
25/02/2011
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,488 0001613926416 1901051010450002
1933
ROFI'AH
PESERTA
01/07/1952
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,489 0001613926427 1901056911490002
1934
SENUT
PESERTA
29/11/1949
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,490 0001613926438 1901054107330010
1935
JAMILAH
PESERTA
01/07/1933
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,491 0001613926449 1901051609490001
1936
ABDULLAH
PESERTA
16/09/1949
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,492 0001613926451 1901054105530001
1936
MARYAM
ISTRI
01/05/1953
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,493 0001613926462 1901056404790001
1936
HOMISAH
ANAK
24/04/1979
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,494 0001613926473 1901050408550001
1939
SUMINTAK
PESERTA
04/08/1955
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,495 0001613926484 1901054704570001
1939
SAINA
ISTRI
07/04/1957
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,496 0001613926495 1901054107630026
1941
ISAH
PESERTA
01/07/1953
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,497 0001613926506 1901050107800026
1941
GAPRI
ANAK
01/07/1980
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,498 0001613926517 1901054107490021
1943
FATEMAH
PESERTA
01/07/1949
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,499 0001613926528 1901051204660002
1944
SUKARDI
PESERTA
12/04/1965
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,500 0001613926539 1901055003490001
1945
HJ.SUAINI
PESERTA
10/03/1949
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,501 0001613926541 1901050508870001
1945
MEZAR KURNIAWAN
ANAK
05/08/1967
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,502 0001613926552 1901051004590001
1947
SABIRIN
PESERTA
10/04/1959
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,503 0001613926563 1901055606630001
1947
SURYANI
ISTRI
16/11/1963
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 457 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,504 0001613926574 1901051009940001
1947
MEDI SAPUTRA
ANAK
15/05/1995
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,505 0001613926585 1901056109030001
1947
NENGSIH
ANAK
21/11/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,506 0001613926596 1901055811480001
1951
MINAH
PESERTA
18/11/1948
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,507 0001613926607 1901054107410009
1952
ZUBAIDAH
PESERTA
01/07/1941
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,508 0001613926618 1901051007760003
1953
AZIS
PESERTA
10/07/1976
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,509 0001613926629 1901055210440001
1954
HJ.ZAITUN
PESERTA
21/01/1944
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,510 0001613926631 1901054107450014
1955
ROSNI
PESERTA
01/07/1945
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,511 0001613926642 1901055612460001
1956
SANTI
PESERTA
16/12/1946
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,512 0001613926653 1901051012620004
1957
TARMIZI
PESERTA
10/12/1962
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,513 0001613926664 1901054305640004
1957
RO'AY
ISTRI
03/05/1964
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,514 0001613926675 1901051201710004
1959
ARYANTO
PESERTA
12/01/1971
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,515 0001613926686 1901054503710002
1959
ASRAH
ISTRI
05/03/1971
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,516 0001613926697 1901052610980003
1959
ALHARI WAHYUDI
ANAK
26/10/1998
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,517 0001613926708 1901055910030004
1959
RAHMAH CICAHYA
ANAK
19/10/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,518 0001613926719 1901056712690002
1963
SUTIPAH
PESERTA
27/12/1969
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,519 0001613926721 1901054107030006
1963
JULIA ASTIRA
ANAK
01/07/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,520 0001613926732 1901051105740003
1965
ROSYADI
PESERTA
11/05/1974
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,521 0001613926743 1901057005700001
1965
ERNA SUSANTI
ISTRI
30/05/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,522 0001613926754 1901055409980003
1965
KRISNAWATI
ANAK
14/09/1998
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,523 0001613926765 1901052412680008
1968
MARFA'I
PESERTA
24/12/1968
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,524 0001613926776 1901055505690005
1968
ROHATI
ISTRI
15/05/1969
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,525 0001613926787 1901050511910006
1968
REVALDI
ANAK
05/11/1991
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,526 0001613926798 1901052905990005
1968
MARGEN RORENDRA
ANAK
29/05/1999
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 458 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,527 0001613926809 1901050701370001
1972
ASLI
PESERTA
01/07/1937
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,528 0001613926811 1901050206550001
1973
HAMID
PESERTA
02/06/1955
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,529 0001613926822 1901054105620001
1973
SAUNAH
ISTRI
01/06/1962
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,530 0001613926833 1901054107530030
1975
PATOMAH
PESERTA
01/07/1953
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,531 0001613926844 1901053108420001
1976
SUKI
PESERTA
31/08/1942
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,532 0001613926855 1901055407660005
1976
ROHATI
ISTRI
14/07/1966
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,533 0001613926866 1901052807000001
1976
IDO MUHLIS
ANAK
28/07/2000
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,534 0001613926877 1901055403030001
1976
SUTINA
ANAK
14/03/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,535 0001613926888 1901054107510010
1980
SAKDA
PESERTA
01/07/1951
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,536 0001613926899 1901084803600004
1981
SALBIAH
PESERTA
08/03/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,537 0001613926901 1901081708950001
1981
HENDRA SAPRI
ANAK
17/08/1995
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,538 0001613926912 1901080604970003
1981
SAMSURI
ANAK
06/04/1997
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,539 0001613926923 1901084806020002
1981
NENG IMA
ANAK
08/06/2002
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,540 0001613926934 1901087001090001
1981
SURYANI
ANAK
30/01/2009
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,541 0001613926945 1901052008640001
1986
JASIMIN
PESERTA
20/08/1964
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,542 0001613926956 1901056807720002
1986
JULIYA
ISTRI
26/07/1972
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,543 0001613926967 1901052309990005
1986
JAYANTO
ANAK
23/09/1999
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,544 0001613926978 1901055001040001
1986
JUMI'A
ANAK
10/01/2004
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,545 0001613926989 1901056606600001
1990
ROSIDA
PESERTA
26/06/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,546 0001613926991 1901052009550004
1991
SUHARDI
PESERTA
20/09/1955
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,547 0001613927002 1901055006650002
1991
ASUNAH
ISTRI
10/06/1965
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,548 0001613927013 1901054310700001
1993
SUMI
PESERTA
03/10/1970
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,549 0001613927024 1901050105040001
1993
EVAN DONI.A
ANAK
01/05/2003
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 459 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,550 0001613927035 1901054107360022
1995
ADIOK
PESERTA
01/07/1936
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,551 0001613927046 1901050101520006
1996
ZAINAL
PESERTA
01/01/1952
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,552 0001613927057 1901054107550018
1996
AMINAH
ISTRI
01/07/1955
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,553 0001613927068 1901056807680001
1998
DARMITI
PESERTA
28/07/1968
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,554 0001613927079 1901056505960004
1998
ECI PRATIWI
ANAK
25/05/1996
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,555 0001613927081 1901050302350001
2000
H.ABDUL AZIZ
PESERTA
03/02/1935
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,556 0001613927092 1901051607630002
2001
SUHARTO
PESERTA
16/07/1960
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,557 0001613927103 1901052406020004
2001
ZEBRI GUSTIAN
ANAK
24/06/2002
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,558 0001613927114 1901051701060001
2001
ZOLA AFRIZA
ANAK
17/01/2006
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,559 0001613927125 1901056203540002
2004
SUYANTI
PESERTA
22/03/1954
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,560 0001613927136 1901054808900002
2004
KURNIATI
ANAK
08/08/1990
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,561 0001613927147 1901054107480011
2006
NAI
PESERTA
01/07/1948
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,562 0001613927158 1901050810820001
2006
DALWAN
ANAK
08/10/1982
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,563 0001613927169 1901051004640001
2008
MASTON
PESERTA
10/04/1964
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,564 0001613927171 1901055009770001
2008
SUSILA
ISTRI
10/09/1977
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,565 0001613927182 1901054411970001
2008
SILVIA ARISKI
ANAK
04/11/1997
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,566 0001613927193 1901055503070001
2008
ZAKIA BELA
ANAK
15/03/2007
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,567 0001613927204 1901052807770003
2012
MUSDAR
PESERTA
28/07/1977
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,568 0001613927215 1901056001770002
2012
SUMANTI
ISTRI
20/01/1977
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,569 0001613927226 1901051703980004
2012
AZIZAH KHOIRI
ANAK
17/03/1998
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,570 0001613927237 1901055211050002
2012
NOVA ZALIANTY
ANAK
11/12/2005
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,571 0001613927248 1901050410860003
2016
RIAL PARDEDE
PESERTA
04/10/1986
PEMALI
01/05/2015
AKTIF
19,225
22/04/2015
10,572 0001613927259 1901013008490001
2017
SE TJO LIE
PESERTA
30/08/1949
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 460 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,573 0001613927261 1901012008800001
2017
SEWANDI
ANAK
20/08/1980
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,574 0001613927272 1901014102650002
2019
NEM NEIH
PESERTA
01/02/1965
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,575 0001613927283 1901011503560003
2020
TJEN SIONG KHIAN
PESERTA
15/03/1956
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,576 0001613927294 1901015410570002
2020
TJONG NGIT LON
ISTRI
14/10/1957
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,577 0001613927305 1901012406310001
2022
THEN DJUNG ON
PESERTA
24/06/1931
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,578 0001613927316 1901016108880013
2023
SHERLY YUNITA ANGGARA
PESERTA
21/06/1988
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,579 0001613927327 1901010411550002
2024
BONG DJIN KHIONG
PESERTA
04/11/1955
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,580 0001613927338 1901017008800001
2024
MIE HO
ISTRI
30/08/1980
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,581 0001613927349 1901012309960001
2024
DODDY
ANAK
23/09/1996
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,582 0001613927351 1901014205990008
2024
RANI YANNI
ANAK
02/05/1999
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,583 0001613927362 1901016003010003
2024
ANITA
ANAK
20/03/2001
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,584 0001613927373 1901014609040001
2024
SELVIANTI
ANAK
06/09/2004
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,585 0001613927384 1901015111130001
2024
MEGA SARI
ANAK
11/11/2013
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,586 0001613927395 1901016709390002
2031
LAIY NAM TJHIN
PESERTA
27/09/1939
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,587 0001613927406 1901011710660002
2031
LAIY NAM SUNG
ANAK
17/10/1966
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,588 0001613927417 1901010709870005
2033
YANTO
PESERTA
07/09/1987
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,589 0001613927428 1901010406890008
2033
HENDRA
TAMBAHAN
04/06/1989
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,590 0001613927439 1901011101960002
2033
HENDRI
TAMBAHAN
01/11/1996
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,591 0001613927441 1901010205550005
2036
SARMADI
PESERTA
02/05/1955
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,592 0001613927452 1901011707940005
2036
RISKI JULIANTO
ANAK
17/07/1994
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,593 0001613927463 1901013006960001
2036
YUDI FIRMANSYAH
ANAK
30/06/1996
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,594 0001613927474 1901015412060002
2036
DHEA ARDIANA
ANAK
14/12/2006
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,595 0001613927485 1901017112580013
2040
ITIN
PESERTA
31/12/1958
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 461 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,596 0001613927496 1901012004920003
2040
DERIYANTO
ANAK
20/04/1992
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,597 0001613927507 1901014712570002
2042
PHAN KIM MOEI
PESERTA
07/12/1957
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,598 0001613927518 1901014804990005
2042
APRIANI
ANAK
08/04/1999
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,599 0001613927529 1901014101310001
2044
FATOKAH
PESERTA
01/01/1931
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,600 0001613927531 1901010812580004
2044
FAHRIZAL
ANAK
08/12/1958
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,601 0001613927542 1901014810260002
2046
BAHIYAN
PESERTA
08/10/1926
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,602 0001613927553 1901015111510001
2046
SUGIARTI
ISTRI
11/11/1951
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,603 0001613927564 1901010509510004
2048
TJHIN KHO NGI
PESERTA
05/09/1951
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,604 0001613927575 1901010408790004
2048
YOTONO
ANAK
04/08/1979
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,605 0001613927586 1901014103500001
2050
MURTENA
PESERTA
01/03/1950
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,606 0001613927597 1901014101500001
2051
ASNIATI
PESERTA
01/01/1950
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,607 0001613927608 1901015111460002
2052
HOLIPAH BINTI KASIM
PESERTA
11/11/1946
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,608 0001613927619 1901015212550003
2053
SUTARSIH
PESERTA
12/12/1955
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,609 0001613927621 1901014203500001
2054
KAMSINAH
PESERTA
02/03/1950
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,610 0001613927632 1901010209690002
2054
TOTO JANUAR
ANAK
02/09/1969
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,611 0001613927643 1901012702740003
2054
RIDWAN
ANAK
27/02/1974
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,612 0001613927654 1901015206420002
2057
ZUNIAR
PESERTA
12/06/1942
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,613 0001613927665 1901011510620002
2057
JUMADI
ANAK
15/10/1962
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,614 0001613927676 1901014704730002
2057
MURBAYANI
ANAK
07/04/1973
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,615 0001613927687 1901016301850003
2057
YUNITA ANA SARI
ANAK
23/01/1985
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,616 0001613927722 1901017112620012
2064
ROKIYATI
PESERTA
31/12/1962
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,617 0001613927733 1901010505750007
2064
SUNARYONO
ANAK
05/05/1975
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,618 0001613927744 1901010602320015
2064
AGUS FITRIYADI
ANAK
08/08/1982
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 462 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,619 0001613927755 1901016708680001
2067
SUKIRAH
PESERTA
27/08/1968
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,620 0001613927766 1901017112340002
2068
SUKIRA
PESERTA
31/12/1934
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,621 0001613927788 1901017112490008
2070
ZAINUR BINTI SEMAT
PESERTA
31/12/1949
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,622 0001613927801 1901015508480002
2072
HALIMAH
PESERTA
15/08/1948
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,623 0001613927812 1901010310710001
2072
OKI LIBRIANTO
ANAK
03/10/1971
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,624 0001613927823 1901011512510002
2074
J.SAGIYO
PESERTA
15/12/1951
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,625 0001613927834 1901015608640001
2075
NARIYE
PESERTA
16/08/1964
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,626 0001613927845 1901012203890001
2075
MOH.IMAM SAFI'I
ANAK
22/03/1989
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,627 0001613927856 1901015704920001
2075
SITI KURNIATI
ANAK
17/04/1992
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,628 0001613927867 1901012206940001
2075
M.ALI MAKKI
ANAK
22/06/1994
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,629 0001613927878 1901016106410002
2079
SULASTRI
PESERTA
21/06/1941
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,630 0001613927889 1901011306680002
2079
TURMUDI
ANAK
13/06/1968
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,631 0001613927891 1901010709720002
2081
SUGITO
PESERTA
07/09/1972
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,632 0001613927902 1901015709000003
2081
PRISCHILLA RIEKE
ANAK
17/09/2000
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,633 0001613927913 1901011903040005
2081
DANIEL KRISTOPHY DUGARI
ANAK
19/03/2004
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,634 0001613927924 1901014101420009
2084
MASNAH
PESERTA
01/01/1942
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,635 0001613927935 1901011811680004
2084
RIDUAN
ANAK
18/11/1968
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,636 0001613927946 1901011504710001
2084
ALFIAN
ANAK
15/04/1971
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,637 0001613927957 1901011603430001
2087
MEDI
PESERTA
16/03/1945
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,638 0001613927968 1901014107450010
2088
NURMALA
PESERTA
01/07/1945
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,639 0001613927979 1901015805450003
2089
DJUMIAH
PESERTA
18/05/1945
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,640 0001613927981 1901012504480001
2090
JONO KASAN
PESERTA
25/04/1948
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,641 0001613927992 1901014301770006
2090
HARYANTI
ISTRI
03/01/1977
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 463 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,642 0001613928003 1901015209540001
2092
FARIDA
PESERTA
17/09/1954
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,643 0001613928014 1901014210420005
2093
FATIMAH
PESERTA
02/10/1942
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,644 0001613928025 1901010805640004
2093
KASYADI
ANAK
08/05/1964
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,645 0001613928036 1901016406670001
2093
KASIYEM
ANAK
24/06/1987
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,646 0001613928047 1901012005820001
2093
SUWARJO
ANAK
20/05/1982
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,647 0001613928058 1901011606830002
2093
SUPARJAN
ANAK
16/08/1983
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,648 0001613928069 1901015002850002
2098
RUTH OCTHA ELVINA
PESERTA
10/02/1995
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,649 0001613928071 1901015602080001
2098
AFFIA ROSSE AMETHYST
ANAK
16/02/2009
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,650 0001613928082 1901012002100002
2098
MARUDUT SITUMORANG
ANAK
20/02/2010
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,651 0001613928093 1901014712130002
2098
DAMERIA VANESA
SITUMORANG
ANAK
07/12/2013
SUNGAILIAT
01/05/2015
AKTIF
19,225
22/04/2015
10,652 0001613928104 1901014909550001
2102
SARIAH
PESERTA
09/09/1955
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,653 0001613928115 1901011803570001
2103
ALI
PESERTA
18/03/1957
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,654 0001613928126 1901014107640013
2103
LIM SAK LIE
ISTRI
01/07/1964
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,655 0001613928137 1901010206000001
2103
JONI HENDRA
ANAK
02/06/2000
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,656 0001613928148 3526102010800002
2106
AHMAD TOLEP
PESERTA
20/10/1980
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,657 0001613928159 3526106907850005
2106
SAIMAH
ISTRI
29/07/1985
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,658 0001613928161 1901010610060011
2106
PAJAR SODIQ
ANAK
06/10/2006
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,659 0001613928172 1901012909130004
2106
HOIRIL IMAM
ANAK
29/09/2013
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,660 0001613928183 1901010311430001
2110
SARIMIN
PESERTA
03/11/1943
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,661 0001613928194 1901016803570002
2110
SUKARTI
ISTRI
28/03/1957
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,662 0001613928205 1901016409490004
2112
HARNALI
PESERTA
24/09/1949
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,663 0001613928216 1901016407700002
2112
AI LIE
ISTRI
24/07/1970
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,664 0001613928227 1901015812300001
2114
TJEN TJHUN MOEK
PESERTA
18/12/1930
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 464 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,665 0001613928238 1901016211610002
2114
TJEN WE LING
ANAK
22/11/1961
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,666 0001613928249 1901015908510001
2116
SIOE FOEN
PESERTA
18/08/1951
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,667 0001613928251 3526104809440001
2117
BUNATI
PESERTA
08/09/1944
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,668 0001613928262 1901014509210001
2118
BONG SOEI NJONG
PESERTA
24/02/1922
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,669 0001613928273 1901010603510002
2118
BONG KON SEN
ANAK
03/05/1952
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,670 0001613928284 1901014202510003
2120
HOEN MIE NON
PESERTA
13/12/1951
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,671 0001613928295 3601290207700006
2121
WASIM
PESERTA
02/07/1970
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,672 0001613928306 3601295504650003
2121
YULETTI HANAH
ISTRI
15/04/1965
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,673 0001613928317 3601296002960004
2121
ADITIAH ARI GAYO
ANAK
20/02/1996
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,674 0001613928328 3601291105100002
2121
WAHYU SETIAWAN
ANAK
11/05/2010
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,675 0001613928339 1901014212990006
2125
TANIA STEPHANIE AURELLIA
PESERTA
02/12/1999
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,676 0001613928341 1901017010300002
2126
FOE NGIT KHIOEN
PESERTA
30/10/1930
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,677 0001613928352 1901015509570005
2126
TJHAIJ KHIOEK NOEN
ISTRI
15/09/1957
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,678 0001613928363 1901010303720002
2128
DANANG PAMUNGKAS
PESERTA
03/03/1972
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,679 0001613928374 1901015208750002
2128
SULASMI HARIYATI
ISTRI
12/08/1975
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,680 0001613928385 1901010808960001
2128
AGUSTIANGGA
ANAK
08/08/1996
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,681 0001613928396 1901012308090002
2128
DIMAS CAICAR WARDANA
ANAK
23/08/2009
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,682 0001613928407 1901011205730012
2132
HIU SUI KIN
PESERTA
12/05/1973
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,683 0001613928418 1971054406800003
2132
WIWI
ISTRI
04/06/1980
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,684 0001613928429 1901016308130003
2132
LOLA FUNG
ANAK
23/08/2013
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,685 0001613928431 1901012010980007
2135
MIEKEL
PESERTA
20/10/1998
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,686 0001613928442 1901011705900006
2136
WAHYUDI
PESERTA
17/05/1990
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,687 0001613928453 1901015104950002
2136
ANITA SAHARA
ISTRI
11/04/1995
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 465 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,688 0001613928464 1901012008130005
2136
RAY VINCENT
ANAK
20/08/2013
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,689 0001613928475 1901011401660001
2139
DJAP SUI FAT
PESERTA
14/01/1966
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,690 0001613928486 1901015509710001
2139
MARDALENA
ISTRI
15/09/1971
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,691 0001613928497 1901015507970004
2139
SENI
ANAK
15/07/1997
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,692 0001613928508 1901012208020001
2139
ANGGA
ANAK
22/08/2002
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,693 0001613928519 1901011111100004
2139
NOVELION
ANAK
11/11/2010
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,694 0001613928521 1901015207650002
2144
DJOENG MIE LIOE
PESERTA
12/07/1965
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,695 0001613928532 1901011911760002
2144
DJOENG TJO LIE
ANAK
26/02/1976
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,696 0001613928543 1901011601390001
2146
NG SOEI BIE
PESERTA
16/01/1939
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,697 0001613928554 1901013010740001
2147
CO DJAM
PESERTA
30/10/1974
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,698 0001613928565 1901016507700002
2147
BOEN HWA JING
ANAK
25/07/1970
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,699 0001613928576 1808081208680001
2149
TUMIRAN
PESERTA
12/08/1968
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,700 0001613928587 1808085109750002
2149
DEWI TRI YANTI
ISTRI
11/09/1975
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,701 0001613928598 1808086810020001
2149
ARDIAH
ANAK
28/10/2002
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,702 0001613928609 1901012603540002
2152
LIOE KONG THIN
PESERTA
26/03/1954
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,703 0001613928611 1901014409650008
2152
LIAN RINI
ISTRI
04/09/1965
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,704 0001613928622 1901010512530004
2154
BOEN TIAN THON
PESERTA
05/12/1953
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,705 0001613928633 1901010208870012
2154
FRANKI
ANAK
02/08/1987
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,706 0001613928644 1901010109670004
2156
BUN KHIN SAN
PESERTA
01/09/1967
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,707 0001613928655 1901014805720004
2156
TJHIN MIE FAN
ISTRI
08/05/1972
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,708 0001613928666 1901011005910006
2156
ALFRIDO
ANAK
10/05/1991
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,709 0001613928677 1901010211940003
2156
STEPHEN
ANAK
02/11/1994
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,710 0001613928688 1901015812980006
2156
VERENT FLORENTIA
ANAK
18/12/1998
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 466 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,711 0001613928699 1901012507070003
2156
HENGKY KURNIAWAN
ANAK
25/07/2007
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,712 0001613928701 1901016003520002
2162
RATNAWATI FATIMAH
PESERTA
20/03/1952
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,713 0001613928712 1901015212390002
2163
TJEN KON NGIT
PESERTA
12/12/1939
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,714 0001613928723 1901013009700002
2163
SETIAWAN SALIM
ANAK
30/09/1970
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,715 0001613928734 1901016212490002
2165
SUKISKIA
PESERTA
22/12/1949
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,716 0001613928745 1901014810750004
2166
TJUNG SUI MUI
PESERTA
08/10/1975
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,717 0001613928756 1901011711000008
2166
VERNANDO LEONARDI
ANAK
17/11/2000
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,718 0001613928767 1901017103070008
2166
LING NAWATI
ANAK
31/03/2007
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,719 0001613928778 1901011611510002
2169
BUN LIAN KONG
PESERTA
16/11/1951
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,720 0001613928789 1901015710410001
2169
TJEN HIONG NIE
ISTRI
17/10/1941
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,721 0001613928791 1901011403620001
2171
THOMAS
PESERTA
14/03/1962
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,722 0001613928802 1901014601770003
2171
NAINI
ISTRI
06/01/1977
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,723 0001613928813 1901011609040002
2171
WELLY YANTO
ANAK
16/09/2004
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,724 0001613928824 1901016702070003
2171
NELLA NATALIE
ANAK
27/02/2007
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,725 0001613928835 1901014293680002
2175
NGIT OI
PESERTA
02/03/1968
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,726 0001613928846 1901015707370001
2176
NGUI TJIT HO
PESERTA
17/07/1937
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,727 0001613928857 1901016011670001
2177
EVENY DYANA
PESERTA
20/11/1967
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,728 0001613928868 1901014808560004
2178
PADALENA
PESERTA
08/08/1956
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,729 0001613928879 1901016505480001
2179
PAUW SAK NJONG
PESERTA
25/05/1948
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,730 0001613928881 1901015702340001
2180
TJUNG SUN WAN
PESERTA
17/02/1934
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,731 0001613928892 1901012112078249
2181
TJEN SAK DJOEN
PESERTA
11/07/1971
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,732 0001613928903 1901016012800004
2181
SEINDA
ISTRI
20/12/1980
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,733 0001613928914 1901012402070004
2181
WILLIAMS BLENSISKY
ANAK
24/02/2007
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 467 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,734 0001613928925 1901011606100004
2181
WILBERT
ANAK
16/06/2010
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,735 0001613928936 1901013004600001
2185
JOHANNES
PESERTA
30/04/1960
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,736 0001613928947 1901014101720006
2185
JULINA
ISTRI
01/01/1972
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,737 0001613928958 1901014312290002
2187
LIE MIE NIE
PESERTA
03/12/1929
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,738 0001613928969 1901012506560001
2188
BOEN TJO KIAN
PESERTA
25/06/1956
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,739 0001613928971 1901014309970003
2188
MEDLIN
ANAK
03/09/1997
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,740 0001613928982 1901010812690003
2190
LAI MIK TJE
PESERTA
08/12/1969
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,741 0001613928993 1901015902500002
2191
LIOE A MIE
PESERTA
19/02/1950
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,742 0001613929004 1901014807570002
2192
LIOE KHIOEK NGIAM
PESERTA
08/07/1957
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,743 0001613929015 1901010904800002
2192
LIOE A HONG
ANAK
09/04/1988
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,744 0001613929026 1901014911580006
2194
RATNA SARI
PESERTA
09/11/1958
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,745 0001613929048 1901011010490002
2196
THAMRIN
PESERTA
10/10/1949
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,746 0001613929059 1901014112500002
2196
MAYANA
ISTRI
01/12/1950
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,747 0001613929061 1901011802690006
2198
HAMID DARSONO
PESERTA
18/02/1969
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,748 0001613929072 1901017103760001
2198
ENI RIWANTI
ANAK
31/03/1976
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,749 0001613929083 1901011209650005
2200
YUSPA SUPMA
PESERTA
12/09/1965
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,750 0001613929094 1901017105720001
2200
MELY TRIDAYANI
ISTRI
31/05/1972
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,751 0001613929105 1901011602030003
2200
YUDI FEBRIAN
ANAK
16/02/2003
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,752 0001613929116 1901011202770002
2203
KEMAD
PESERTA
12/02/1977
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,753 0001613929127 1901014211580004
2203
TRASMI YUNI ASTUTI
ISTRI
02/11/1968
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,754 0001613929138 1901011310010003
2203
OKY MUHAMMAD NOVAL
ANAK
13/10/2001
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,755 0001613929149 1901015807510001
2206
TJHANG SUI IN
PESERTA
18/07/1951
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,756 0001613929151 1901012408890008
2207
DJUNG FO
PESERTA
24/08/1989
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 468 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,757 0001613929162 1901016408380001
2208
LO A SOEN
PESERTA
24/08/1938
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,758 0001613929173 1901010908500002
2209
HOMAN SUTANTO
PESERTA
09/08/1950
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,759 0001613929184 1901016802500003
2209
NG SOEI LIAN
ISTRI
28/02/1950
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,760 0001613929195 1901014305520004
2211
PHOENG MIE LON
PESERTA
03/05/1952
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,761 0001613929206 1901010101020001
2212
FERRIE
PESERTA
01/01/2002
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,762 0001613929217 1901016506050001
2212
CHRISTIA MEILA
TAMBAHAN
25/05/2005
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,763 0001613929228 1901014903700005
2214
SRI MULYANI
PESERTA
08/03/1970
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,764 0001613929239 1901011011670003
2215
JIUW HWE
PESERTA
10/11/1967
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,765 0001613929241 1901012707380002
2216
M. Syafei Syarip
PESERTA
27/07/1938
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,766 0001613929252 1901016512500002
2216
Eva Syarifah Ainul Yakin
ISTRI
25/12/1950
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,767 0001613929263 1901014509760003
2216
Amelia Wati
ANAK
05/09/1976
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,768 0001613929274 1901012501770002
2216
Jamin Zazi
ANAK
25/01/1977
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,769 0001613929285 1901010108800007
2216
Joni Sarosi
ANAK
01/08/1980
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,770 0001613929296 1901014606900001
2216
Henny Rafiqoh
ANAK
06/06/1988
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,771 0001613929307 1901011310910009
2216
Henry Gunawan
ANAK
14/10/1991
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,772 0001613929318 1901011505710005
2223
SUYATNO
PESERTA
15/05/1971
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,773 0001613929329 1901015012730004
2223
JUMINI
ISTRI
10/12/1973
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,774 0001613929331 1901015302930001
2223
RUPIANI
ANAK
13/02/1993
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,775 0001613929342 1901014204970002
2223
APRILLIA FATMALA
ANAK
02/04/1997
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,776 0001613929353 1901011803910004
2227
MOH. HADI
PESERTA
18/03/1991
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,777 0001613929364 1901017112650002
2228
IDA ROSLAINI
PESERTA
31/12/1965
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,778 0001613929375 1901012304910003
2228
FECKRIADI
ANAK
23/04/1991
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,779 0001613929386 1901016808940002
2228
DIAN VITIANI
ANAK
28/08/1994
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
12/2/15 3:16 PM
Page 469 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,780 0001613929397 1901013006690005
2231
HERMANTO
PESERTA
30/06/1969
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,781 0001613929408 1901016006770001
2231
ENDAH MULYANINGSIH
ISTRI
10/06/1977
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,782 0001613929419 1901010608090003
2231
MUHAMMAD MUFFID HERDIAN ANAK
05/08/2009
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,783 0001613929421 1901010908100004
2231
DIVI RAHMAN BASTARI
ANAK
09/08/2010
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,784 0001613929432 1901016402140001
2231
HANA KHALILAH ANGGUN
ANAK
24/02/2014
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,785 0001613929443 3510090505760012
2236
MISNADI
PESERTA
05/05/1978
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,786 0001613929454 3510094506880004
2236
YULIYANI
ISTRI
05/08/1988
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,787 0001613929465 3510090905070002
2236
MULYADI PRATAMA
ANAK
09/05/2007
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,788 0001613929476 1901061609710002
2239
FIRDAUS
PESERTA
15/09/1971
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,789 0001613929487 1901011906650002
2240
DARWIN
PESERTA
19/06/1965
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,790 0001613929498 1901017112660002
2240
NUR ELIYA SARITA
ISTRI
31/12/1966
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,791 0001613929509 1901011702900002
2240
RENDI FEBRI AKBAR
ANAK
17/02/1990
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,792 0001613929511 1901016912960002
2240
PUPUT EVITA SARI
ANAK
29/12/1996
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,793 0001613929522 1901010903860003
2244
TRY MUSTABIRIN
PESERTA
09/03/1985
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,794 0001613929533 1901014506940001
2244
KARTINI
ISTRI
05/06/1994
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,795 0001613929544 1901012702830003
2246
ZULFIKRI
PESERTA
27/02/1983
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,796 0001613929555 1601095105840001
2246
MARHAMA
ISTRI
11/05/1984
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,797 0001613929566 1901012408100001
2246
AHMAD ASHARY RAMADAN
ANAK
24/08/2010
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,798 0001613929577 1901011604690005
2249
Rachman Djaya .S
PESERTA
16/04/1969
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,799 0001613929588 1901014606750003
2249
Ani Setiawati
ISTRI
06/06/1975
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,800 0001613929599 1901012405040004
2249
Sendi Sanjaya
ANAK
24/05/2004
KENANGA
01/05/2015
AKTIF
19,225
22/04/2015
10,801 0001794735821 1901012205590001
MUSTAPA
PESERTA
22/05/1959
SINAR BARU
01/11/2015
AKTIF
19,225
19/10/2015
10,802 0001794736113 1901015609630004
JUMINAH
ISTRI
16/09/1963
SINAR BARU
01/11/2015
AKTIF
19,225
05/12/2014
12/2/15 3:16 PM
Page 470 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,803 0001796281413 1901050606680001
KASWADI
PESERTA
06/06/1968
PEMALI
01/11/2015
AKTIF
19,225
19/10/2015
10,804 0001796283707 1901054205760001
siti fatimah
ISTRI
02/05/1976
PEMALI
01/11/2015
AKTIF
19,225
10/12/2014
10,805 0001796286543 1901052703890002
zeny prasetiya
ANAK
27/03/1989
PEMALI
01/11/2015
AKTIF
19,225
10/12/2014
10,806 0001796287959 1901050204940002
RICO AFILIANTO
ANAK
02/04/1994
PEMALI
01/11/2015
AKTIF
19,225
10/12/2014
10,807 0001796291087 1901050201000001
erwin dayu saputra
ANAK
02/01/2000
PEMALI
01/11/2015
AKTIF
19,225
10/12/2014
10,808 0001796293089 1901052410010003
akhmad wildani
ANAK
24/10/2001
PEMALI
01/11/2015
AKTIF
19,225
10/12/2014
10,809 0001796294878 1901055412050003
devi angilliana
ANAK
14/12/2005
PEMALI
01/11/2015
AKTIF
19,225
10/12/2014
10,810 0001796724268 1901022707670001
HASAN BASRI
PESERTA
27/07/1967
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/04/2015
10,811 0001796725901 1901024901710001
ELTONA
ISTRI
01/09/1971
SUNGAILIAT
01/05/2015
AKTIF
19,225
10/12/2014
10,812 0001800688713 1901020602720003
EKOLISTIAN FABRIANTO
PESERTA
06/02/1972
BELINYU
01/10/2015
AKTIF
19,225
15/09/2015
10,813 0001800935998 1901011501800003
HERI SANTOSO
PESERTA
15/01/1980
SUNGAILIAT
01/07/2015
AKTIF
19,225
16/06/2015
10,814 0001801010518 1901014806840006
NOVI YUNITA SARI
ISTRI
08/06/1984
SUNGAILIAT
01/07/2015
AKTIF
19,225
18/12/2014
10,815 0001801021691 1901012105060003
JUJU HERU SAPUTRA
ANAK
21/05/2006
SUNGAILIAT
01/07/2015
AKTIF
19,225
18/12/2014
10,816 0001801024391 1901014407070002
YULIA PATMA HERA
ANAK
04/07/2007
SUNGAILIAT
01/07/2015
AKTIF
19,225
18/12/2014
10,817 0001800952097 1901024407780001
SULASTRI
PESERTA
04/07/1978
BELINYU
01/10/2015
AKTIF
19,225
15/09/2015
10,818 0001800959771 1901026506120003
ALENA DIVA PRIMA
PESERTA
25/06/2012
BELINYU
01/10/2015
AKTIF
19,225
15/09/2015
10,819 0001800970514 1901026811970001
NANI AYU LESTARI
PESERTA
28/11/1997
BELINYU
01/10/2015
AKTIF
19,225
15/09/2015
10,820 0001802742309 1901020602090001
ANANDA FEBRIAN
PESERTA
06/02/2009
BELINYU
01/10/2015
AKTIF
19,225
15/09/2015
10,821 0001806292056 1901030606520004
NGIT JUNG
PESERTA
06/06/1952
BATURUSA
01/04/2015
AKTIF
19,225
17/03/2015
10,822 0001806299572 1901034806540002
LIAN KIM MOI
ISTRI
08/06/1954
BATURUSA
01/04/2015
AKTIF
19,225
29/12/2014
10,823 0001806306118 1901036808830001
LILINA
ANAK
28/08/1983
BATURUSA
01/04/2015
AKTIF
19,225
29/12/2014
10,824 0001808349287 1902016409780005
YENNY
PESERTA
24/09/1978
KENANGA
01/04/2015
AKTIF
19,225
17/03/2015
10,825 0001808349985 1902011904010003
rendy pratama
ANAK
19/04/2001
KENANGA
01/04/2015
AKTIF
19,225
05/01/2015
12/2/15 3:16 PM
Page 471 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,826 0001808351065 1902015812030003
ditta putri karuna
ANAK
18/12/2003
KENANGA
01/04/2015
AKTIF
19,225
05/01/2015
10,827 0001808352044 1902010212070003
ferdy triandra
ANAK
02/12/2007
KENANGA
01/04/2015
AKTIF
19,225
05/01/2015
10,828 0001808352955 1902010311090001
refandy forrendra
ANAK
03/11/2009
KENANGA
01/04/2015
AKTIF
19,225
05/01/2015
10,829 0001808555949 1901014503820006
WASINI
PESERTA
05/03/1982
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/04/2015
10,830 0001808562025 1901011610020002
AHMAD ROHADI
ANAK
16/10/2002
SUNGAILIAT
01/05/2015
AKTIF
19,225
05/01/2015
10,831 0001808562576 1901015107080001
SITI FATIMAH
ANAK
11/07/2008
SUNGAILIAT
01/05/2015
AKTIF
19,225
05/01/2015
10,832 0001808563149 1901016210090001
TRI KOMSIYAH
ANAK
22/10/2009
SUNGAILIAT
01/05/2015
AKTIF
19,225
05/01/2015
10,833 0001813467071 1901051104940001
IDI AMIN
PESERTA
11/04/1994
PEMALI
01/10/2015
AKTIF
19,225
15/09/2015
10,834 0001813467205 1901057112530003
SABARIAH
ISTRI
31/12/1953
PEMALI
01/10/2015
AKTIF
19,225
16/01/2015
10,835 0001815223825 1901054809510001
MIDA
PESERTA
08/09/1951
PEMALI
01/11/2015
AKTIF
19,225
19/10/2015
10,836 0001816302644 1901022008620002
MARTANI
PESERTA
20/08/1962
BELINYU
01/12/2015
AKTIF
19,225
19/11/2015
10,837 0001816316954 1901024212970002
NURUL HIDAYANTI
SUAMI
02/12/1997
BELINYU
01/12/2015
AKTIF
19,225
22/01/2015
10,838 0001816310665 1901026911690003
MAHAYATI
ISTRI
29/11/1969
BELINYU
01/12/2015
AKTIF
19,225
22/01/2015
10,839 0001816322321 1901021310040001
MUHAMMAD ILHAM
NAZARUDIN
ANAK
13/10/2004
BELINYU
01/12/2015
AKTIF
19,225
22/01/2015
10,840 0001816324806 1901024212020001
INDAH FITRIA
ANAK
02/12/2002
BELINYU
01/12/2015
AKTIF
19,225
22/01/2015
10,841 0001817993507 1901012012630005
RUDI HADINATA
PESERTA
20/12/1963
KENANGA
01/04/2015
AKTIF
19,225
17/03/2015
10,842 0001819231975 1901011404640001
MATTA'IE
PESERTA
14/04/1964
SINAR BARU
01/09/2015
AKTIF
19,225
19/08/2015
10,843 0001819233674 1901016707620003
sutia
ISTRI
27/07/1962
SINAR BARU
01/09/2015
AKTIF
19,225
29/01/2015
10,844 0001819874136 1901010508780002
SAZI VELA ROGI
PESERTA
05/08/1978
SINAR BARU
01/09/2015
AKTIF
19,225
19/08/2015
10,845 0001819874327 1901014103840001
MELIANITA
ISTRI
01/03/1984
SINAR BARU
01/09/2015
AKTIF
19,225
31/01/2015
10,846 0001819874463 1901015201990002
ELA SILVIA
ANAK
12/01/1999
SINAR BARU
01/09/2015
AKTIF
19,225
31/01/2015
10,847 0001819874564 1901012912020003
EMANSYAHDAN
ANAK
29/12/2002
SINAR BARU
01/09/2015
AKTIF
19,225
31/01/2015
10,848 0001821357966 1901080107660010
MUHSIN
PESERTA
01/07/1966
PUDING BESAR
01/06/2015
AKTIF
19,225
15/05/2015
12/2/15 3:16 PM
Page 472 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,849 0001821358912 1901084601660001
rohani
ISTRI
08/01/1966
PUDING BESAR
01/06/2015
AKTIF
19,225
04/02/2015
10,850 0001821359261 1901081010963002
muhammad abdul rozik
ANAK
10/10/1993
PUDING BESAR
01/06/2015
AKTIF
19,225
04/02/2015
10,851 0001821359496 1901082203980001
muhammad imam anggi
ANAK
22/03/1998
PUDING BESAR
01/06/2015
AKTIF
19,225
04/02/2015
10,852 0001821359799 1901086605050002
henna
ANAK
26/05/2005
PUDING BESAR
01/06/2015
AKTIF
19,225
04/02/2015
10,853 0001822328785 1901041912590002
TAJUDIN
PESERTA
19/12/1959
PENAGAN
01/04/2015
AKTIF
19,225
17/03/2015
10,854 0001822329382 1901044808740003
RODIANA
ISTRI
08/08/1974
PENAGAN
01/04/2015
AKTIF
19,225
06/02/2015
10,855 0001822329707 1901041101980004
RAMADANI
ANAK
11/01/1998
PENAGAN
01/04/2015
AKTIF
19,225
06/02/2015
10,856 0001822329966 1901040605020001
RAJA SAPUTRA
ANAK
06/05/2002
PENAGAN
01/04/2015
AKTIF
19,225
06/02/2015
10,857 0001822330361 1901044505060005
NADILA
ANAK
05/05/2006
PENAGAN
01/04/2015
AKTIF
19,225
06/02/2015
10,858 0001823823167 1901031002900002
NUGRAHA PRIMA
PESERTA
10/02/1990
BATURUSA
01/04/2015
AKTIF
19,225
17/03/2015
10,859 0001823823843 1901036802944001
RUSNI
ISTRI
28/02/1994
BATURUSA
01/04/2015
AKTIF
19,225
11/02/2015
10,860 0001823824563 1901032907130001
muhammad zilly maulana
ANAK
29/07/2013
BATURUSA
01/04/2015
AKTIF
19,225
11/02/2015
10,861 0001824729794 1901012802540001
MALIK ALIAS
PESERTA
28/02/1954
SINAR BARU
01/05/2015
AKTIF
19,225
16/04/2015
10,862 0001824731482 1901016909620002
MISNAH
ISTRI
29/09/1962
SINAR BARU
01/05/2015
AKTIF
19,225
13/02/2015
10,863 0001824733179 1901016905790006
kartina
ANAK
29/05/1989
SINAR BARU
01/05/2015
AKTIF
19,225
13/02/2015
10,864 0001824733811 1901013106020003
karmizi
ANAK
31/08/2002
SINAR BARU
01/05/2015
AKTIF
19,225
13/02/2015
10,865 0001827025795 1901032405750002
TAUFIK
PESERTA
24/05/1975
BATURUSA
01/04/2015
AKTIF
19,225
17/03/2015
10,866 0001827028462 1901035606750004
SITI MAIMUNAH
ISTRI
16/06/1975
BATURUSA
01/04/2015
AKTIF
19,225
20/02/2015
10,867 0001827039723 1901031304960001
RENDI PRATAMA KUSUMA
ANAK
13/04/1996
BATURUSA
01/04/2015
AKTIF
19,225
20/02/2015
10,868 0001827040004 1901031904020002
REKI PERNANDO
ANAK
19/04/2002
BATURUSA
01/04/2015
AKTIF
19,225
20/02/2015
10,869 0001831806099 1901012104790007
AFRIANSYAH
PESERTA
21/04/1979
SINAR BARU
01/10/2015
AKTIF
19,225
15/09/2015
10,870 0001831806527 1901016210870008
HANANIAH
ISTRI
22/10/1987
SINAR BARU
01/10/2015
AKTIF
19,225
05/03/2015
10,871 0001831807269 1901014309080001
SYAFIRA KHEYZIA
ANAK
03/09/2008
SINAR BARU
01/10/2015
AKTIF
19,225
05/03/2015
12/2/15 3:16 PM
Page 473 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,872 0001831807991 1901025606250007
ZHEVA AURELIA REVAZA
ANAK
05/05/2014
SINAR BARU
01/10/2015
AKTIF
19,225
05/03/2015
10,873 0001834812235 1901070107380002
ISMAIL
PESERTA
01/07/1938
RIAU SILIP
01/05/2015
AKTIF
19,225
16/04/2015
10,874 0001835356937 1901017108870002
ATY SEFTYA NINGSIH
PESERTA
31/08/1987
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/04/2015
10,875 0001835355148 1901011410850003
SIGIT HADISUWARNO
SUAMI
14/10/1985
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/03/2015
10,876 0001835358535 1901012301100001
REYHAN ABIMEYZA
ANAK
23/01/2010
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/03/2015
10,877 0001835359885 1901016211140001
QAIREEN AZZALEA
ANAK
22/11/2014
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/03/2015
10,878 0001835857708 1901035908080001
NAJLA
PESERTA
19/08/2008
01/05/2015
AKTIF
19,225
16/04/2015
10,879 0001835858575 1901032503110001
MUHAMMAD ZALDY HASAN
PESERTA
25/03/2011
01/05/2015
AKTIF
19,225
16/04/2015
10,880 0001836372609 1901040510710004
SALA'UDIN
PESERTA
05/10/1971
PETALING
01/06/2015
AKTIF
19,225
12/05/2015
10,881 0001836376762 1901044806940003
SANTIYANA
ANAK
08/06/1994
PETALING
01/06/2015
AKTIF
19,225
18/03/2015
10,882 0001836381047 1901045302020005
ROBIATUL ADAWIYAH
ANAK
13/02/2002
PETALING
01/06/2015
AKTIF
19,225
18/03/2015
10,883 0001836383174 1901041802060003
muhammad ansori
ANAK
18/02/2006
PETALING
01/06/2015
AKTIF
19,225
18/03/2015
10,884 0001836384388 1901046204090001
astari
ANAK
22/04/2009
PETALING
01/06/2015
AKTIF
19,225
18/03/2015
10,885 0001836823217 7404101610780001
LA ODE HAYUDIN
PESERTA
16/10/1978
SUNGAILIAT
01/05/2015
AKTIF
19,225
16/04/2015
10,886 0001836823869 7404104107800117
WA ODE ELVIANTI
ISTRI
01/07/1980
SUNGAILIAT
01/05/2015
AKTIF
19,225
19/03/2015
10,887 0001836824679 7404101912980001
LM.SYAIFULLAH.R
ANAK
19/12/1998
SUNGAILIAT
01/05/2015
AKTIF
19,225
19/03/2015
10,888 0001836825309 7404104403020001
WA ODE RISPUPUT
ANAK
04/03/2002
SUNGAILIAT
01/05/2015
AKTIF
19,225
19/03/2015
10,889 0001836825816 7404101103070001
LM.SYAFRULLAH
ANAK
11/03/2007
SUNGAILIAT
01/05/2015
AKTIF
19,225
19/03/2015
10,890 0001836826266 1901014401100003
SERINA STANIA WA ODE
ANAK
04/01/2010
SUNGAILIAT
01/05/2015
AKTIF
19,225
19/03/2015
10,891 0001838592988 1901075908860001
GUSTIVANA
PESERTA
19/08/1986
SINAR BARU
01/05/2015
AKTIF
19,225
16/04/2015
10,892 0001838593686 1901077004110001
VALENCIA
ANAK
30/04/2011
SINAR BARU
01/05/2015
AKTIF
19,225
24/03/2015
10,893 0001838594169 1901076503140003
PERISELA
ANAK
25/03/2014
SINAR BARU
01/05/2015
AKTIF
19,225
24/03/2015
10,894 0001840337122 1901010101920008
SAHBANI
PESERTA
01/01/1992
SINAR BARU
01/05/2015
AKTIF
19,225
16/04/2015
12/2/15 3:16 PM
Page 474 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,895 0001840337943 1901015208930007
rosi ersida
ISTRI
12/08/1993
SINAR BARU
01/05/2015
AKTIF
19,225
30/03/2015
10,896 0001840338562 1901017003120001
asyha adelia cantika
ANAK
30/03/2012
SINAR BARU
01/05/2015
AKTIF
19,225
30/03/2015
10,897 0001843371415 1901021806750004
ISKANDAR
PESERTA
18/06/1975
BELINYU
01/07/2015
AKTIF
19,225
16/06/2015
10,898 0001843372721 1901025010760001
FATMAWATI
ISTRI
10/10/1976
BELINYU
01/07/2015
AKTIF
19,225
09/04/2015
10,899 0001843374137 1901024305990002
DIAN SANDRA
ANAK
03/05/1999
BELINYU
01/07/2015
AKTIF
19,225
09/04/2015
10,900 0001843375408 1905012408030001
MUHAMMAD REHAN SAPUTRA ANAK
24/08/2003
BELINYU
01/07/2015
AKTIF
19,225
09/04/2015
10,901 0001843377579 1901022807050002
MUHAMMAD RIO PRATAMA
ANAK
28/07/2005
BELINYU
01/07/2015
AKTIF
19,225
09/04/2015
10,902 0001843378435 1901024611070002
RENI DESTIANI
ANAK
06/11/2007
BELINYU
01/07/2015
AKTIF
19,225
09/04/2015
10,903 0001843380022 1901026601100004
REVANI ANGGERAINI
ANAK
26/01/2010
BELINYU
01/07/2015
AKTIF
19,225
09/04/2015
10,904 0001844624755 1901026606750009
DESY MARTINI
PESERTA
25/05/1975
BELINYU
01/06/2015
AKTIF
19,225
12/05/2015
10,905 0001844625385 1901024605020002
ike safitri
ANAK
06/06/2002
BELINYU
01/06/2015
AKTIF
19,225
14/04/2015
10,906 0001844625745 1901025208060001
indah agustin
ANAK
12/08/2006
BELINYU
01/06/2015
AKTIF
19,225
14/04/2015
10,907 0001845316945 1901026710750001
ROSMAWATI
PESERTA
27/10/1975
BELINYU
01/10/2015
AKTIF
19,225
15/09/2015
10,908 0001845319195 1901026303980009
yuni
ANAK
23/03/1998
BELINYU
01/10/2015
AKTIF
19,225
16/04/2015
10,909 0001845320027 1901024102040001
adha
ANAK
01/02/2004
BELINYU
01/10/2015
AKTIF
19,225
16/04/2015
10,910 0001846881369 3674060104750017
ZAINAL ABIDIN
PESERTA
01/04/1975
PEMALI
01/06/2015
AKTIF
19,225
12/05/2015
10,911 0001846882462 3674064805780016
lina marlina
ISTRI
08/05/1978
PEMALI
01/06/2015
AKTIF
19,225
21/04/2015
10,912 0001846882967 3674062501070006
m.rizqon hasanan
ANAK
25/01/2007
PEMALI
01/06/2015
AKTIF
19,225
21/04/2015
10,913 0001846883597 3674061609080011
m.jayyid jidan
ANAK
16/09/2008
PEMALI
01/06/2015
AKTIF
19,225
21/04/2015
10,914 0001846884609 3674061804110004
M.FARDAN FADILA
ANAK
18/04/2011
PEMALI
01/06/2015
AKTIF
19,225
21/04/2015
10,915 0001846885601 1901052802130001
M.SIROJUL ISLAM
ANAK
28/02/2013
PEMALI
01/06/2015
AKTIF
19,225
21/04/2015
10,916 0001846893352 1901011605810004
MULYADI
PESERTA
16/05/1981
SUNGAILIAT
01/06/2015
AKTIF
19,225
15/05/2015
10,917 0001846894533 1901016406860004
ELYAWATI
ISTRI
24/06/1986
SUNGAILIAT
01/06/2015
AKTIF
19,225
21/04/2015
12/2/15 3:16 PM
Page 475 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,918 0001846895319 1901011110060005
REZA RAHMA YADI
ANAK
11/10/2006
SUNGAILIAT
01/06/2015
AKTIF
19,225
21/04/2015
10,919 0001846896219 1901011110060006
REZI RAHMA YADI
ANAK
11/10/2006
SUNGAILIAT
01/06/2015
AKTIF
19,225
21/04/2015
10,920 0001846896862 1901016308120001
VELA AULIA LESTARI
ANAK
23/08/2012
SUNGAILIAT
01/06/2015
AKTIF
19,225
21/04/2015
10,921 0001847362048 1901010103330002
LIAUW DJAT NGIE
PESERTA
01/03/1930
KENANGA
01/06/2015
AKTIF
19,225
15/05/2015
10,922 0001849312416 1901012911780005
AMRONI
PESERTA
29/11/1978
SINAR BARU
01/09/2015
AKTIF
19,225
19/08/2015
10,923 0001849313248 1901015411770003
YENNI
ISTRI
14/11/1977
SINAR BARU
01/09/2015
AKTIF
19,225
28/04/2015
10,924 0001849316692 1901015205990003
MEGA SARI
ANAK
12/05/1999
SINAR BARU
01/09/2015
AKTIF
19,225
28/04/2015
10,925 0001849317039 1901014102030008
FEBRINA
ANAK
01/02/2003
SINAR BARU
01/09/2015
AKTIF
19,225
28/04/2015
10,926 0001849319346 1901011304110001
FATIH AHMAT
ANAK
13/04/2011
SINAR BARU
01/09/2015
AKTIF
19,225
28/04/2015
10,927 0001851375407 1901036103630001
SUMAINI
PESERTA
21/03/1963
KENANGA
01/06/2015
AKTIF
19,225
15/05/2015
10,928 0001851376555 1901030107610029
sapri
SUAMI
01/07/1961
KENANGA
01/06/2015
AKTIF
19,225
06/05/2015
10,929 0001851377016 1901031907950001
raimundo
ANAK
19/07/1995
KENANGA
01/06/2015
AKTIF
19,225
06/05/2015
10,930 0001851377319 1901030605010003
uji haryanto
ANAK
06/05/2001
KENANGA
01/06/2015
AKTIF
19,225
06/05/2015
10,931 0001855299148 1901031205680002
KALIMAN
PESERTA
12/05/1968
01/09/2015
AKTIF
19,225
19/08/2015
10,932 0001855300127 1901034107710018
ROSINA
ISTRI
01/07/1971
01/09/2015
AKTIF
19,225
20/05/2015
10,933 0001141257126 1901032706900003
SANDRI
ANAK
27/06/1990
01/09/2015
AKTIF
19,225
15/01/2014
10,934 0001855304335 1901037006940002
desi karmila
ANAK
30/06/1994
01/09/2015
AKTIF
19,225
20/05/2015
10,935 0001855305022 1901031510990002
rozani
ANAK
15/10/1999
01/09/2015
AKTIF
19,225
20/05/2015
10,936 0001855305538 1901036210060002
devi karyani
ANAK
22/10/2005
01/09/2015
AKTIF
19,225
20/05/2015
10,937 0001858335862 1901014201820009
BINA TRIYANTI
PESERTA
02/01/1982
SUNGAILIAT
01/10/2015
AKTIF
19,225
15/09/2015
10,938 0001858336424 1901016705060003
meiza arini zulianty
ANAK
27/05/2006
SUNGAILIAT
01/10/2015
AKTIF
19,225
28/05/2015
10,939 0001859286802 1901051405040001
HAFIZ HASBY
PESERTA
14/05/2004
SUNGAILIAT
01/11/2015
AKTIF
19,225
19/10/2015
10,940 0001861409891 1901010810590001
HASAN BASRI
PESERTA
08/10/1959
SINAR BARU
01/09/2015
AKTIF
19,225
19/08/2015
12/2/15 3:16 PM
Page 476 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,941 0001861410767 1901016301630001
marinah
ISTRI
23/01/1963
SINAR BARU
01/09/2015
AKTIF
19,225
10/06/2015
10,942 0001861411162 1901010806810004
hendri susanto
ANAK
08/06/1981
SINAR BARU
01/09/2015
AKTIF
19,225
10/06/2015
10,943 0001861411836 1901016311870005
liliza herlinda
ANAK
23/11/1987
SINAR BARU
01/09/2015
AKTIF
19,225
10/06/2015
10,944 0001863535544 1901011801720001
JANUAR
PESERTA
18/01/1972
SINAR BARU
01/11/2015
AKTIF
19,225
19/10/2015
10,945 0001865266042 1901010504830004
SUHERMAN
PESERTA
05/04/1983
SINAR BARU
01/09/2015
AKTIF
19,225
19/08/2015
10,946 0001865266841 1901015209760005
fitriana
ISTRI
12/09/1976
SINAR BARU
01/09/2015
AKTIF
19,225
23/06/2015
10,947 0001865267346 1901010506140004
fathan aldzuhri
ANAK
05/06/2014
SINAR BARU
01/09/2015
AKTIF
19,225
23/06/2015
10,948 0001865268011 1901017011970004
rukmini
TAMBAHAN
30/11/1997
SINAR BARU
01/09/2015
AKTIF
19,225
23/06/2015
10,949 0001865268415 1901012701060002
jarkoni
TAMBAHAN
27/01/2005
SINAR BARU
01/09/2015
AKTIF
19,225
23/06/2015
10,950 0001867033089 1901010708570004
HARDIONO
PESERTA
07/08/1957
SINAR BARU
01/11/2015
AKTIF
19,225
19/10/2015
10,951 0001867033776 1901014305680002
rumiati
ISTRI
03/05/1968
SINAR BARU
01/11/2015
AKTIF
19,225
30/06/2015
10,952 0001867034687 1901014208920002
winda lestari
ANAK
02/08/1992
SINAR BARU
01/11/2015
AKTIF
19,225
30/06/2015
10,953 0001867035339 1901011510050002
angga prasetyo nugroho
ANAK
15/10/2005
SINAR BARU
01/11/2015
AKTIF
19,225
30/06/2015
10,954 0001867035881 1901011109070001
a'an wicaksono
ANAK
11/09/2007
SINAR BARU
01/11/2015
AKTIF
19,225
30/06/2015
10,955 0001867166897 1901012208750004
JUNARWAN
PESERTA
22/08/1975
SINAR BARU
01/10/2015
AKTIF
19,225
15/09/2015
10,956 0001867167404 1901015212770004
sumisnah
ISTRI
22/12/1977
SINAR BARU
01/10/2015
AKTIF
19,225
30/06/2015
10,957 0001867168113 1901010306030006
aditya arwandana
ANAK
03/06/2003
SINAR BARU
01/10/2015
AKTIF
19,225
30/06/2015
10,958 0001867168449 1901015308060003
rasya salsabila
ANAK
13/08/2006
SINAR BARU
01/10/2015
AKTIF
19,225
30/06/2015
10,959 0001867992579 1901012101780004
MUHAMMADIYAH
PESERTA
21/01/1978
SUNGAILIAT
01/09/2015
AKTIF
19,225
19/08/2015
10,960 0001867993773 1901065302870001
SHOLI KHATIN
ISTRI
13/02/1987
SUNGAILIAT
01/09/2015
AKTIF
19,225
03/07/2015
10,961 0001868150676 1901014906860006
RATNA
PESERTA
09/06/1986
SUNGAILIAT
drg. IGN. ADITYA KRISNANTO P.
01/11/2015
AKTIF
19,225
19/10/2015
10,962 0001868150935 1901012912030001
RYAN NANDA FUTRA
ANAK
29/12/2003
SUNGAILIAT
01/11/2015
AKTIF
19,225
03/07/2015
10,963 0001868151194 1901013101080001
RANGGA SAPUTRA
ANAK
31/01/2008
dr. ANDY TANOR
01/11/2015
AKTIF
19,225
03/07/2015
12/2/15 3:16 PM
Page 477 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,964 0001871129441 1901057009790003
NURJINAH
PESERTA
30/09/1979
SUNGAILIAT
01/10/2015
AKTIF
19,225
15/09/2015
10,965 0001871130385 1901052104920003
ahmad zam zami
TAMBAHAN
21/04/1992
SUNGAILIAT
01/10/2015
AKTIF
19,225
22/07/2015
10,966 0001876218355 1901016303630003
SWANTIN
PESERTA
23/03/1963
SINAR BARU
01/11/2015
AKTIF
19,225
19/10/2015
10,967 0001876218816 1901012003900005
handra
ANAK
20/03/1990
SINAR BARU
01/11/2015
AKTIF
19,225
11/08/2015
10,968 0001876219299 1901016209980001
ega pradika
ANAK
22/09/1998
SINAR BARU
01/11/2015
AKTIF
19,225
11/08/2015
10,969 0001878619217 1901010512640007
LUKMAN
PESERTA
05/12/1964
SINAR BARU
01/11/2015
AKTIF
19,225
19/10/2015
10,970 0001878619768 1901016512650001
sulastri
ISTRI
25/12/1965
SINAR BARU
01/11/2015
AKTIF
19,225
20/08/2015
10,971 0001878620422 1901014812060005
syakira intias
ANAK
03/12/2006
SINAR BARU
01/11/2015
AKTIF
19,225
20/08/2015
10,972 0001878620769 1901010111720004
daryanto
TAMBAHAN
11/11/1972
SINAR BARU
01/11/2015
AKTIF
19,225
20/08/2015
10,973 0001878621118 1901014306760001
maryuni
TAMBAHAN
13/06/1976
SINAR BARU
01/11/2015
AKTIF
19,225
20/08/2015
10,974 0001882153809 1901011406640001
PENDI
PESERTA
14/06/1964
SUNGAILIAT
01/12/2015
AKTIF
19,225
19/11/2015
10,975 0001882154171 1901014211580001
kalsum
ISTRI
02/11/1958
SUNGAILIAT
01/12/2015
AKTIF
19,225
02/09/2015
10,976 0001882154553 1901011011870001
zayadi
ANAK
10/11/1987
SUNGAILIAT
01/12/2015
AKTIF
19,225
02/09/2015
10,977 0001882154845 1901010907890002
suhaili
ANAK
09/07/1989
SUNGAILIAT
01/12/2015
AKTIF
19,225
02/09/2015
10,978 0001882155126 1901016007930001
rosiah
ANAK
20/07/1993
SUNGAILIAT
01/12/2015
AKTIF
19,225
02/09/2015
10,979 0001886426289 1901052107680002
MAJERI
PESERTA
21/07/1968
PEMALI
01/12/2015
AKTIF
19,225
19/11/2015
10,980 0001886427437 1900562037400001
sarita
ISTRI
29/03/1974
PEMALI
01/12/2015
AKTIF
19,225
16/09/2015
10,981 0001886428798 1901055603970001
desi pansela
ANAK
16/03/1997
PEMALI
01/12/2015
AKTIF
19,225
16/09/2015
10,982 0001892187538 1901013112690003
NURDIN
PESERTA
31/12/1969
SUNGAILIAT
01/12/2015
AKTIF
19,225
19/11/2015
10,983 0001892188146 1901015205700001
erlina
ISTRI
12/05/1970
SUNGAILIAT
01/12/2015
AKTIF
19,225
07/10/2015
10,984 0001892188495 1901014712910001
desitaria
ANAK
12/07/1991
SUNGAILIAT
01/12/2015
AKTIF
19,225
07/10/2015
10,985 0001892188811 1901012104010005
wahyudi
ANAK
21/04/2001
SUNGAILIAT
01/12/2015
AKTIF
19,225
07/10/2015
10,986 0001892189283 1901013107030001
parli irfanda
ANAK
31/07/2003
SUNGAILIAT
01/12/2015
AKTIF
19,225
07/10/2015
12/2/15 3:16 PM
Page 478 of 479

Sub Entitas :
Periode
: 12 - 2015
No.
No. Kartu
NIK
NPP/Nopeg Nama
Hub. Keluarga
Tgl. Lahir
Nama Faskes Gigi
TMT
Status Peserta
10,987 0001893555213 1901010401670001
ICHSAN SOLIHIN
PESERTA
04/01/1967
SUNGAILIAT
01/12/2015
AKTIF
19,225
19/11/2015
10,988 0001893555977 1901016712700008
SULASTRI
ISTRI
27/12/1970
SUNGAILIAT
01/12/2015
AKTIF
19,225
12/10/2015
10,989 0001893556743 1901011609950003
MUHMMAD ROMARIO
ANAK
16/09/1995
SUNGAILIAT
01/12/2015
AKTIF
19,225
12/10/2015
10,990 0001893557529 1901014307000003
ANNASTASYA BALQIES
ANAK
03/07/2000
SUNGAILIAT
01/12/2015
AKTIF
19,225
12/10/2015
10,991 0001894786896 1901042606860005
BADARUDIN
PESERTA
26/06/1986
PETALING
01/12/2015
AKTIF
19,225
19/11/2015
10,992 0001894787561 1901046608910001
SITI HAWA
ISTRI
26/08/1991
PETALING
01/12/2015
AKTIF
19,225
16/10/2015
10,993 0001894788922 1901044402090004
SUAIBATUL MUSLIMAH
ANAK
04/02/2009
PETALING
01/12/2015
AKTIF
19,225
16/10/2015
10,994 0001894789585 1901044503100001
SHIFA AMELIYA
ANAK
05/03/2010
PETALING
01/12/2015
AKTIF
19,225
16/10/2015
10,995 0001895160666 1901016802410002
CIW A CIA
PESERTA
28/02/1941
KENANGA
01/11/2015
AKTIF
19,225
16/10/2015
10,996 0001898381676 1901010702620006
SELAMET
PESERTA
07/03/1962
SUNGAILIAT
01/12/2015
AKTIF
19,225
25/11/2015
10,997 0001898382071 1901015104830007
NURLELA
ISTRI
11/04/1983
SUNGAILIAT
01/12/2015
AKTIF
19,225
27/10/2015
10,998 0001898382407 1901012402100003
RIZQI AKBAR PRATAMA
ANAK
24/02/2010
SUNGAILIAT
01/12/2015
AKTIF
19,225
27/10/2015
10,999 0001898382712 1901010207130001
ACHMAD NUR IMAN
ANAK
02/07/2013
SUNGAILIAT
01/12/2015
AKTIF
19,225
27/10/2015
11,000 0001899902643 1901052305920001
MUHAMMAD ROZALI
PESERTA
23/05/1992
PEMALI
01/12/2015
AKTIF
19,225
19/11/2015
02 December 2015 15.16.05

Cat : Luaran ini adalah Daftar Peserta kondisi pada tanggal :
yang mana bisa terjadi penambahan dan pengurangan data peserta
sehingga tidak bisa dijadikan acuan untuk dijadikan sebagai Tagihan Iuran
12/2/15 3:16 PM
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DAFTAR PESERTA PER ENTITAS

Nama Entitas : PEMERINTAH KABUPATEN BANGKA (01080098)

Nama Faskes Tingkat I

Nama Faskes Gigi

Iuran Tgl. Registrasi

HELMI ERNITA ARITONANG

RIDHO AKBAR SAFUTRA

DOSY PUTRI MAYANDA

ARINDAH CAHAYA PUTRI

LIE MOI TUNG

PHOENG TJIT NIE

Nama Entitas : PEMERINTAH KABUPATEN BANGKA (01080098)

Nama Faskes Tingkat I

Nama Faskes Gigi

Iuran Tgl. Registrasi

MEIRINDA RESTU ADANTI

Nama Entitas : PEMERINTAH KABUPATEN BANGKA (01080098)

Nama Faskes Tingkat I

Nama Faskes Gigi

Iuran Tgl. Registrasi

Nama Entitas : PEMERINTAH KABUPATEN BANGKA (01080098)

Nama Faskes Tingkat I

Nama Faskes Gigi

Iuran Tgl. Registrasi

vinaka tuwensti pradini

rama danis wara

RAISHA KLARA SABRINA

dr. MUJI ATMOJO

MUHAMMAD RAHLIL AKBAR

Nama Entitas : PEMERINTAH KABUPATEN BANGKA (01080098)

Nama Faskes Tingkat I

Nama Faskes Gigi

Iuran Tgl. Registrasi

MUHAMMAD RIZKI PRATAMA

EVIN FEI RICARLA

drg. DEWI SEPTARIA (JST)

Nama Entitas : PEMERINTAH KABUPATEN BANGKA (01080098)

Nama Faskes Tingkat I

Nama Faskes Gigi

Iuran Tgl. Registrasi

drg. DEWI SEPTARIA (JST)

drg. DEWI SEPTARIA (JST)

drg. DEWI SEPTARIA (JST)

RAHMAT TOPIK HAMZAH

Nama Entitas : PEMERINTAH KABUPATEN BANGKA (01080098)

Nama Faskes Tingkat I

Nama Faskes Gigi

Iuran Tgl. Registrasi

HALI MATU SAKDIAH

BIJANA OVI PRTAMA

Nama Entitas : PEMERINTAH KABUPATEN BANGKA (01080098)

Nama Faskes Tingkat I

Nama Faskes Gigi

Iuran Tgl. Registrasi

SELVILIA MONA GITA

SELLY LIA SANG DWI SRI ASIH ANAK

drg. DEWI SEPTARIA (JST)

Nama Entitas : PEMERINTAH KABUPATEN BANGKA (01080098)

Nama Faskes Tingkat I

Nama Faskes Gigi

Iuran Tgl. Registrasi

drg. DEWI SEPTARIA (JST)

drg. DEWI SEPTARIA (JST)