We report on the diagnosis, pathology, and taxonomy of Perkinsus sp. infection in Manila clams (Ruditapes philippinarum) from Korean waters. Amplimers were designed from internal portions of the non-transcribed spacer (NTS) of P. atlanticus for molecular diagnosis of Perkinsus infection. PCR-based identification methods and an in situ hybridization assay were developed for detection of Perkinsus sp. in live tissues as well as in histological preparations. Hybridization signals were observed around the nucleus of trophozoites. Positive results from PCR and in situ hybridization indicated that Korean Perkinsus sp. is genetically identical with P. atlanticus reported in Europe, which is currently synonymous with P. olseni reported from Australia. Microscopic morphological features of different lift stages of Perkinsus sp. appeared very similar to those of P. atlanticus. Severely infected clams often exhibited white nodules on their mantles and gills as a consequence of inflammation. In lightly to moderately infected clams, Perkinsus sp. was mainly found in gill tissues, whereas the protozoan parasites were found in digestive tracts, gonadal tissues, and foot tissues of heavily infected clams. It is likely that the gills are the portal of the infection and that P. olseni spreads to other tissues as the infection advances. In conclusion, by considering the taxonomic priority of P. olseni, Korean Perkinsus sp. is accepted as P. olseni. P. olseni appears to be common on tidal flats on the western and southern Korean coasts and is considered to be a pathogen capable of causing mass mortality of clams.