The effects of fuel injection nozzle hole on the NOx emission and fuel oil consumption of medium speed diesel engine HYUNDAI HiMSEN 6H21/32 engine are investigated by engine performance simulation. The results of performance simulation are verified by experimental results of NOx omission fuel oil consumption, cylinder pressure, and heat release rate according to the variation of the number of fuel injection nozzle hole and engine load. The performance simulations are also carried out to optimize the fuel injection nozzle of 6H21/32 engine in respect to the NOx emission and fuel oil consumption. The engine performance measurements are performed to verify the results of performance simulation and to investigate the effects of fuel injection nozzle on engine performance. The results of measurement indicate that significant NOx reduction can be achieved with minimum deterioration in fuel oil consumption by optimizing the geometry of fuel injection nozzle on 6H21/32 engine.